Abstract Details

Title Consideration for ICU Admission in New-onset Encephalitis Patients: A Clinical Decision Model Development and Validation Study Based on Two Multicenter Cohorts

Topic Neuro Trauma and Critical Care

Presentation(s) P9 - Poster Session 9 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-002

Objective

To Develop a risk score for predicting intensive care unit (ICU) admission in patients with new-onset encephalitis.

Background

Encephalitis patients can experience severe neurological or systemic complications. ICU care, when appropriate and timely, may be associated with better prognosis. Therefore, it is essential to identify encephalitis patients promptly who require ICU for optimal management and allocation of resources, particularly when ICU bed capacity is limited.

Design/Methods

This retrospective study was conducted on 634 adult patients diagnosed with encephalitis using the International Encephalitis Consortium guidelines. The study included 17 hospitals in Houston, Texas (cohort-1) and 2 hospitals in Baltimore, Maryland (cohort-2), and included 372 and 262 encephalitis patients, respectively. The study had two parts: 1) description of clinical characteristics, complications, and outcomes of ICU-admitted patients compared to non-ICU-admitted patients, and 2)creation and validation of a risk score to predict ICU admission.

Results

Of 634 encephalitis patients, 255 (40%) were admitted to ICU ; of these, 19% developed status epilepticus, 42% required vasopressors, and 75% required mechanical ventilation. Patients admitted to ICU had higher mortality (18.4% vs. 2.9%, p<0.001) and worse outcomes. On logistic regression of cohort-1 focal neurological signs, seizure, leukocytosis, FOUR score <14 at presentation, and medical history of CKD, were associated with ICU (p<0.05). Using these variables, a risk model was created with a total of 9 points and an area under receiver operating characteristics curve (AUROC) of 0.77 (95% CI 0.72-0.82), p<0.001. Patients were classified into 3 subgroups for possible consideration of ICU care: low risk [12/87 (14%)], intermediate risk [120 /246 (49%], and high risk [13/14 (93%)]. This model was successfully externally validated in cohort-2 with an AUROC of 0.757 (95% CI 0.687-0.826, p<0.001).

Conclusions

This risk score may aid physicians as they decide to provide intensity of care for adult patients presenting with new onset encephalitis.

Authors/Disclosures
Ralph Habis, MD (Johns Hopkins School of Medicine) PRESENTER	Dr. Habis has nothing to disclose.
Ashley Heck	No disclosure on file
Paris Bean	No disclosure on file
John Probasco, MD, FAAN (The Johns Hopkins Hospital)	Dr. Probasco has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Clinician. The institution of Dr. Probasco has received research support from Roche/Genentech.
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.
Rodrigo Hasbun	Rodrigo Hasbun has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biomeriaux. The institution of Rodrigo Hasbun has received research support from Biomeriaux.
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.

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