Figure 1.
Flow diagram of inclusion and exclusion of the study. AIE, autoimmune encephalitis; IVIG, intravenous immunoglobulin; IVMP, intravenous pulse methylprednisolone; KCMH, King Chulalongkorn Memorial Hospital; PLEX, plasma exchange.
Table 1.
Baseline characteristics of 44 patients hospitalized due to AIE at the King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, between January 2015 and December 2019
| Total (n = 44) n (%) | IVIG group (n = 34) n (%) | PLEX group (n = 10) n (%) | P | |
|---|---|---|---|---|
| Median (IQR) age, years | 44.5 (28.0–62.5) | 50.5 (28.0–70.0) | 37.5 (24.0–55.0) | 0.14 |
| Gender | 0.70 | |||
| Male | 13 (29.5) | 11 (32.4) | 2 (20.0) | |
| Female | 31 (70.5) | 23 (67.7) | 8 (80.0) | |
| mRS at admission | 0.43 | |||
| Median (IQR) | 3.0 (2.0–3.0) | 3.0 (2.0–3.0) | 3.0 (3.0–3.0) | 0.65 |
| 2 | 14 (31.8) | 12 (35.3) | 2 (20.0) | |
| 3 | 27 (61.4) | 19 (55.9) | 8 (80.0) | |
| 4 | 3 (6.8) | 3 (8.8) | 0 (0) | |
| Cancer | 6 (13.6) | 5 (14.7) | 1 (10.0) | >0.99 |
| Diabetes mellitus | 6 (13.6) | 5 (14.7) | 1 (10.0) | >0.99 |
| Cirrhosis | 1 (2.3) | 1 (2.9) | 0 (0) | 0.77 |
| Currently using immunosuppressive drugs† | 3 (6.8) | 3 (8.8) | 0 (0) | >0.99 |
| Place of admission | 0.13 | |||
| ICU | 3 (6.8) | 1 (2.9) | 2 (20.0) | |
| Regular ward | 41 (93.2) | 33 (97.1) | 8 (80.0) | |
| Type of antibodies | 0.61 | |||
| Intracellular | 14 (31.8) | 12 (35.3) | 2 (20.0) | |
| Neuronal surface | 24 (54.6) | 18 (52.9) | 6 (60.0) | |
| Ab negative | 6 (13.6) | 4 (11.8) | 2 (20.0) |
† Immunosuppressive drugs are the prior use of steroid-sparing immunosuppressants or high-dose corticosteroids [22] including prednisolone of >40 mg/d or equivalent dose which did not include treatment with IVMP during admission. The details of the 3 patients are as follows: azathioprine, azathioprine plus prednisolone 60 mg/d, and tacrolimus plus mycophenolate mofetil.
Figure 2.
Cumulative incidence of HAIs of patients hospitalized due to AIE, categorized by those who received PLEX and IVIG. AIE, autoimmune encephalitis; HAIs, hospital-acquired infections; IVIG, intravenous immunoglobulin; PLEX, plasma exchange.
Table 2.
Occurrence of infectious complication during hospitalization, duration of hospitalization, degree of disability at discharge, and total direct cost of hospitalization of patients hospitalized due to AIE
| Total (n = 44) n (%) | IVIG group (n = 34) n (%) | PLEX group (n = 10) n (%) | P | |
|---|---|---|---|---|
| HAI | 10 (22.7) | 5 (14.7) | 5 (50.0) | 0.03* |
| Duration of hospitalization (d) | 0.05 | |||
| ≤7 | 11 (25.0) | 11 (32.5) | 0 (0) | |
| 8–30 | 24 (54.5) | 18 (52.9) | 6 (60) | |
| >30 | 9 (20.5) | 5 (14.7) | 4 (40) | |
| Median (IQR) | 16.5 (7.5–28.0) | 12.0 (6.0–23.0) | 25.0 (21.0–49.0) | 0.01* |
| mRS at discharge | 0.31 | |||
| 0 | 1 (2.3) | 1 (2.9) | 0 (0) | |
| 1 | 20 (45.5) | 17 (50.0) | 3 (30.0) | |
| 2 | 19 (43.2) | 14 (41.2) | 5 (50.0) | |
| 3 | 1 (2.3) | 1 (2.9) | 0 (0) | |
| 5 | 1 (2.3) | 0 (0) | 1 (10.0) | |
| 6 | 2 (4.5) | 1 (2.9) | 1 (10.0) | |
| Median (IQR) | 2.0 (1.0–2.0) | 1.0 (1.0–2.0) | 2.0 (1.0–2.0) | 0.12 |
| Median (IQR) of differences in mRS between admission and discharge | −1.0 (−2.0 to −1.0) | −1.0 (−2.0 to −1.0) | −1.0 (−2.0 to −1.0) | 0.57 |
| Median (IQR) total direct cost of hospitalization, USD† | 8,063.9 (6,378.9–11,149.3) | 8,322.9 (6,698.8–10,402.2) | 7,024.8 (6,206.1–12,838.0) | 0.54 |