Abstract Details

Title Utilization of Routine Biomarkers for Prediction of an Infectious or Autoimmune Etiology in Encephalitis

Topic Autoimmune Neurology

Presentation(s) Autoimmune Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 030

Objective

This study aims to identify clinical biomarkers at presentation that may be predictive of identification of an infectious pathogen versus autoantibody in patients with encephalitis.

Background

The initial presentation and workup for infectious, particularly viral, and autoimmune encephalitis are similar. Definite diagnosis often takes days to weeks, which may delay treatment.

Design/Methods

This is a multi-center retrospective study in New York City analyzing demographic and clinical data from patients with pathogen/autoantibody-confirmed encephalitis.

Results

333 individuals with definitively diagnosed encephalitis were included. Viral pathogen was identified in 151/333 (45.40%), bacterial pathogen in 95/333 (28.50%), and autoantibody in 87/333 (26.10%).

The following differed between individuals with a viral compared to autoimmune etiology: presence of fever (viral 62.25%, autoimmune 24.10%; p<0.001), CSF WBC (viral median 78cells/µL, autoimmune median 8.00cells/µL; p<0.001), CSF protein (viral median 76.50mg/dL, autoimmune median 40.90mg/dL; p<0.001), CSF glucose (viral median 58.00mg/dL, autoimmune median 69.00mg/dL; p<0.001), serum WBC (viral median 7.80cells/µL, autoimmune median 9.72cells/µL; p<0.05), ESR (viral median 19.50mm/HR, autoimmune median 13.00mm/HR; p<0.05), CRP (viral median 6.40mg/L, autoimmune median 1.25mg/L; p=0.005), and antinuclear antibody titers (>1:40; viral 11.54%, autoimmune 32.73%; p<0.001).

Multivariate regression found the odds of an autoimmune, compared to viral, etiology were lower in individuals presenting with fever (OR 0.30 (95% CI 0.12-0.68); p<0.05), normal serum WBC (OR 2.50 (95% CI 1.39-4.48); p<0.05), and elevated CSF WBC (OR 0.86 (95% CI (0.78-0.93); p<0.001). Individuals aged 20-44 years (OR 3.30 (95% CI 1.17-9.29); p<0.05) and 45-64 years (OR 3.42 (95% CI (1.17-10.01); p<0.05) had higher odds of an autoimmune than viral etiology compared to those >64 years.

Analyses showed similar results when comparing all individuals with infectious (bacterial and viral) etiologies to those with autoimmune etiology.

Conclusions

Specific clinical biomarkers obtained at initial presentation may support which patients have an infectious versus autoimmune encephalitis.

Authors/Disclosures
Hai Ethan Hoang, MD (Weill Cornell Medicine) PRESENTER	Dr. Hoang has nothing to disclose.
Jessica Robinson Papp, MD, FAAN (Icahn School of Medicine At Mount Sinai)	Dr. Robinson Papp has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Immgenuity Inc. Dr. Robinson Papp has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Neuropathix Inc. The institution of Dr. Robinson Papp has received research support from NIH. Dr. Robinson Papp has received publishing royalties from a publication relating to health care.
	No disclosure on file
Kiran Thakur, MD, FAAN (Columbia University College of Physicians and Surgeons)	Dr. Thakur has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Delve Bio.
Rachelle Dugue, MD, PhD	Dr. Dugue has nothing to disclose.
Eileen Harrigan, MD (New York University-Langone)	Dr. Harrigan has nothing to disclose.
Carla Kim	Carla Kim has nothing to disclose.
	No disclosure on file
	No disclosure on file
Allison P. Navis, MD (Mount Sinai Hospital)	The institution of Dr. Navis has received research support from NIH Loan Repayment Program.
	No disclosure on file
Mu Ji Hwang, MD	Dr. Hwang has nothing to disclose.
Nathalie Jette, MD, MSc, FRCPC, FAAN (University of Calgary)	Dr. Jette has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE Epilepsia. The institution of Dr. Jette has received research support from NIH. The institution of Dr. Jette has received research support from AES.
Anusha Yeshokumar, MD (Icahn School of Medicine at Mount Sinai)	Dr. Yeshokumar has nothing to disclose.

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