Influencing factors for delayed diagnosis of autoimmune encephalitis
10.19845/j.cnki.zfysjjbzz.2025.0121
- VernacularTitle:自身免疫性脑炎诊断延迟的相关因素研究
- Author:
Xinbo ZHANG
1
Author Information
1. Department of Neurology， Xijing Hospital， Air Force Medical University， Xi’an 710032， China
- Publication Type:Journal Article
- Keywords:
Autoimmune encephalitis;
Delayed diagnosis;
Influencing factors
- From:
Journal of Apoplexy and Nervous Diseases
2025;42(7):631-636
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize common antibody types and clinical symptoms during the acute phase of autoimmune encephalitis （AE）， to investigate the influencing factors for delayed diagnosis， and ultimately to reduce misdiagnosis rate， improve the prognosis of patients， and reduce medical expenses. Methods Antibody-positive AE patients who were diagnosed in 7 grade A tertiary hospitals from different provinces in China from 2018 to 2022 were enrolled， and related clinical data were collected. Univariate and multivariate logistic regression analyses were used to identify the influencing factors for delayed diagnosis （time from symptom onset to confirmed diagnosis >4 weeks）， and the receiver operating characteristic curve and the nomogram predictive model were constructed. The calibration curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess the degree of calibration of the nomogram predictive model， and a decision curve analysis was used to assess the clinical effectiveness of the nomogram. Results A total of 394 AE patients who met the inclusion and exclusion criteria were enrolled， among whom there were 226 male patients （57.4%）. The median length of hospital stay was 16（12，23） days for all patients， and 89 patients （22.6%） had a history of treatment in the intensive care unit. Of all patients，171（43.4%） experienced delayed diagnosis.Age（OR=1.016）， memory impairment （OR=2.337）， hallucination （OR=1.665）， and sleep disorders（OR=1.818） were independent risk factors for delayed diagnosis.Of all patients，329（83.5%） were misdiagnosed before the confirmed diagnosis of AE. During the acute phase， 332 patients（84.3%）presented with psychiatric and behavioral abnormalities， 289（73.4%） had symptomatic epilepsy， 258（65.5%） had cognitive impairment，and 154（39.1%） had sleep disorders. The CASE scale score was（9.4±4.1） on admission. Electroencephalographic abnormalities were observed in 294 patients（74.6%）， and magnetic resonance imaging abnormalities were detected in 210 patients（53.3%）， with lesions mainly located in the temporal and frontal lobes. Conclusion Delayed diagnosis of AE is common in China， which is mainly associated with an old age， and memory impairment， hallucination， and sleep disorders are also risk factors for delayed diagnosis.
- Full text:2025081115441171122自身免疫性脑炎诊断延迟的相关因素研究.pdf
