Table_1_Predictive value of the neutrophil-to-lymphocyte ratio for treatment response in patients diagnosed with definite or probable autoimmune encephalitis/encephalopathy.DOCX

IntroductionAutoimmune encephalitis/encephalopathy (AE) is a complex and heterogeneous disease, making it difficult to predict the prognosis. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential prognostic tool, but its usefulness remains a matter of debate. This study aimed to explore prognostic factors in cases of clinically definite or probable AE, including those with autoantibody-negative, or unknown status.
MethodsData on patients diagnosed with definite or probable AE, including those with autoantibody-negative, or unknown status, were retrospectively collected from the admission records of our department between January 2013 and December 2022. These patients were then categorized into either a good- or poor-response group, based on their short-term treatment response. Clinical characteristics, auxiliary examinations, and treatments were compared between the two groups. A multivariable logistic regression model was constructed to identify independent predictors of poor short-term treatment response by Akaike information criterion backward stepwise method.
ResultsA total of 31 patients were included in the final analysis, with 18 of them included in the poor-response group. In the univariable analysis, the poor-response group had a higher proportion of patients with a modified Rankin Scale (mRS) high score upon admission, female, epileptic seizures, or NLRs of 3.93 or higher than the good-response group (all p < 0.10). Furthermore, the multivariable logistic regression analysis revealed that the mRS score upon admission [OR: 5.51, 95% confidence intervals (CI): 1.29–23.50, p = 0.02], epileptic seizures (OR: 10.01, 95% CI: 1.16–86.66, p = 0.04), and NLRs of 3.93 or higher (OR: 11.37, 95% CI: 1.12–114.68, p = 0.04) were significantly associated with poor short-term treatment response.
ConclusionThe NLR may play a supplementary role in predicting the short-term treatment response in patients diagnosed with definite or probable AE, including those with autoantibody-negative, or unknown status.

引言：自身免疫性脑炎/脑病（autoimmune encephalitis/encephalopathy, AE）是一类复杂且异质性极强的疾病，其预后预测颇具难度。中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）已被视作潜在的预后评估工具，但其临床应用价值仍存在争议。本研究旨在探索临床确诊或拟诊AE患者（包括自身抗体阴性或抗体状态未知的患者）的预后影响因素。
方法：本研究回顾性收集了2013年1月至2022年12月期间，我科收治的确诊或拟诊AE患者的入院病历数据，纳入人群涵盖自身抗体阴性及抗体状态未知的病例。依据患者短期治疗应答情况，将其划分为治疗应答良好组与治疗应答不良组。随后对两组患者的临床特征、辅助检查结果及治疗方案进行对比分析。采用赤池信息准则（Akaike information criterion, AIC）反向逐步法构建多变量逻辑回归模型，以筛选短期治疗应答不良的独立预测因子。
结果：最终共有31例患者纳入最终分析，其中18例被归入治疗应答不良组。单因素分析结果显示，相较于治疗应答良好组，治疗应答不良组患者入院时改良Rankin量表（modified Rankin Scale, mRS）评分较高、女性占比更高、伴癫痫发作以及NLR≥3.93的患者比例均显著更高（所有P值均<0.10）。进一步的多变量逻辑回归分析显示，入院时mRS评分[优势比（odds ratio, OR）：5.51，95%置信区间（confidence intervals, CI）：1.29~23.50，P=0.02]、癫痫发作（OR：10.01，95%CI：1.16~86.66，P=0.04）以及NLR≥3.93（OR：11.37，95%CI：1.12~114.68，P=0.04）均与短期治疗应答不良存在显著相关性。
结论：对于临床确诊或拟诊的AE患者（包括自身抗体阴性或抗体状态未知的病例），NLR可作为辅助预测其短期治疗应答的补充指标。