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Abstract Details

Acute Encephalitis in the ICU: Predictors of Poor Outcome
Critical Care/Emergency Neurology/Trauma
P03 - (-)
148
BACKGROUND: Acute encephalitis can lead to rapid clinical deterioration requiring specialized intensive care management. There are limited data on elements of ICU care that are predictive of poor outcome in this patient population.
DESIGN/METHODS: A retrospective analysis of encephalitis cases in the ICU at Johns Hopkins Hospital (JHH) from 1997-2011 was performed. Of the 438 patients identified in the JHH encephalitis database, 79 met our inclusion criteria of age greater than 16 years admitted to the ICU for at least 48 hours. Primary outcome was dichotomized as good outcome with discharge to home or rehabilitation, and poor outcome as death, discharge to nursing home or another hospital. Etiology of encephalitis, host-related factors, clinical course, ICU care and complications were subjected to univariate and multivariate chi-square analysis.
RESULTS: In our cohort of 79 encephalitis patients with ICU hospital stays, the median age was 54 years (IQR 16), 48% were male, 39% diagnosed with viral encephalitis, 16.5% had status epilepticus, 15% had evidence of diffuse cerebral edema and mortality was 17.7%. Univariate predictors of poor outcome were: age>65 years (p=0.02), status epilepticus (p=0.04), intubation requirement (p= 0.03), and thrombocytopenia (p=0.01). On multivariate analysis, poor outcome was associated with status epilepticus (OR=7.1, p=0.03), thrombocytopenia (OR=6.8, p=0.02) and intubation (OR=3.7, p=0.05). Age>65 years, cerebral edema, status epilepticus, endotracheal intubation, and thrombocytopenia were associated with increased mortality. Conversely, etiology of encephalitis, GCS on admission, burst suppression EEG pattern, and ventilator-associated pneumonia were not found to be predictive of poor outcome.
CONCLUSIONS: Our study shows that in severe acute encephalitis predictors of poor outcome and death include potentially reversible conditions such as cerebral edema, status epilepticus and thrombocytopenia. These findings suggest that prevention, early detection and aggressive management of these factors in the ICU may modify outcome.
Authors/Disclosures
Kiran Thakur, MD, FAAN (Columbia University College of Physicians and Surgeons)
PRESENTER 		Dr. Thakur has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Delve Bio.
Melissa Motta, MD, MPH, FAAN (University Of Maryland Hospital in Baltimore) Dr. Motta has nothing to disclose.
Anthony O. Asemota, MBBS (Johns Hopkins University, Neurology) No disclosure on file
David R. Benavides, MD, PhD, FAAN (University of Maryland School of Medicine) The institution of Dr. Benavides has received research support from NIH/NINDS. The institution of Dr. Benavides has received research support from F. Hoffman La Roche Ltd.
Justin C. McArthur, MBBS, MPH, FAAN (Johns Hopkins University) No disclosure on file
Romergryko G. Geocadin, MD, FAAN (Johns Hopkins University School of Medicine) Dr. Geocadin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Consulting.
Arun Venkatesan, MD, PhD (Johns Hopkins Hospital) Dr. Venkatesan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen Pharmaceuticals. The institution of Dr. Venkatesan has received research support from NIH. The institution of Dr. Venkatesan has received research support from U.S. DOD.
Frauke Zipp, MD (University Medical Center Mainz) Dr. Zipp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene. Dr. Zipp has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Dr. Zipp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Octapharma. Dr. Zipp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Zipp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Zipp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TEVA. The institution of Dr. Zipp has received research support from BMBF. The institution of Dr. Zipp has received research support from DFG. The institution of Dr. Zipp has received research support from PMSA. The institution of Dr. Zipp has received research support from Sanofi Genzyme. The institution of Dr. Zipp has received research support from UCB. The institution of Dr. Zipp has received research support from Eisai. The institution of Dr. Zipp has received research support from SK Life Science. The institution of Dr. Zipp has received research support from Abbott. The institution of Dr. Zipp has received research support from Actelion. The institution of Dr. Zipp has received research support from Bayer. The institution of Dr. Zipp has received research support from Servier. Dr. Zipp has received personal compensation in the range of $500-$4,999 for serving as a Reviewer with Novartis. Dr. Zipp has received personal compensation in the range of $0-$499 for serving as a Reviewer with Universite de Geneve. Dr. Zipp has received personal compensation in the range of $5,000-$9,999 for serving as a Reviewer with Oppenheim Förderpreis für Multiple Sklerose. Dr. Zipp has received personal compensation in the range of $500-$4,999 for serving as a Reviewer with EKFS. Dr. Zipp has a non-compensated relationship as a Associate Editor with Brain that is relevant to AAN interests or activities. Dr. Zipp has a non-compensated relationship as a Advisor with Science Translational Medicine that is relevant to AAN interests or activities.