Autoimmune encephalitis in the ICU
April 24, 2020
Patients with AE often require care in an ICU. A group at Johns Hopkins led by Dr. John Probasco, discusses clinical presentation, diagnostic approaches, and treatment options for AE with particular focus on the central role the intensivist plays in this process.
In a retrospective study at a tertiary referral center, 55% of patients meeting consensus clinical criteria for possible AE were admitted to the ICU. Patients at particular risk for ICU admission are those who had a longer duration of symptoms before hospitalization and anemia. Seizures, cognitive decline, and respiratory failure are the most common indications for neurocritical care. Almost 70% of patients with AE have critical care needs at some point during their initial hospital stay, with ICU stays greater than four days observed in 44% of patients in one study. Patients with AE are at risk for a variety of neurological and medical complications, with a mortality rate ranging from 12 – 40% in the ICU. Factors associated with poor neurologic outcomes after AE include a delayed start in immunotherapy, longer ICU stay, and the need for mechanical ventilation, amongst others.
Intensivists play a central role in the multidisciplinary management of AE patients, particularly in light of frequently associated complications such as status epilepticus, cardiovascular instability, and the need for mechanical ventilation. ICU-level management is also critical, given the high rate of mortality among patients with AE and to help optimize their outcomes.
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