Validation of a risk score to differentiate autoimmune and viral encephalitis: a Nationwide Cohort Study in Denmark

Lasse Fjordside*, Mette Scheller Nissen, Anna Maria Florescu, Merete Storgaard, Lykke Larsen, Lothar Wiese, Hans Rudolf von Lüttichau, Micha Phill Grønholm Jepsen, Birgitte Rønde Hansen, Christian Østergaard Andersen, Jacob Bodilsen, Henrik Nielsen, Morten Blaabjerg, Anne-Mette Lebech, Helene Mens

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Abstract

Background
A score to differentiate autoimmune (AE) and viral encephalitis (VE) early upon admission has recently been developed but needed external validation. The objective of this study was to evaluate the performance of the score in a larger and more diagnostically diverse patient cohort.

Methods
We conducted a retrospective nationwide and population-based cohort study including all adults with encephalitis of definite viral (2015–2022) or autoimmune aetiology (2009–2022) in Denmark. Variables included in the score-model were extracted from patient records and individual risk scores were assessed. The performance of the score was assessed by receiver-operating characteristics (ROC) curve analyses and calculation of the area under the curve (AUC).

Results
A total of 496 patients with encephalitis [AE n = 90, VE n = 287 and presumed infectious encephalitis (PIE) n = 119] were included in the study. The score was highly accurate in predicting cases of AE reaching an AUC of 0.94 (95% CI 0.92–0.97). Having a score ≥ 3 predicted AE with a PPV of 87% and an NPV of 91%. The risk score was found to perform well across aetiological subgroups and applied to the PIE cohort resulted in an AUC of 0.88 (95% CI 0.84–0.93).

Conclusion
The excellent performance of the score as reported in the development study was confirmed in this significantly larger and more diverse cohort of patients with encephalitis in Denmark. These results should prompt further prospective testing with wider inclusion criteria.
OriginalsprogEngelsk
TidsskriftJournal of Neurology
Vol/bind271
Udgave nummer8
Sider (fra-til)4972-4981
Antal sider10
ISSN0340-5354
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
Open access funding provided by National Hospital. LF was supported by a research grant from the Research Fund of Copenhagen University Hospital-Rigshospitalet. AML was supported by a research grant from the Lundbeck Foundation. Role of the funder: The Research Fund of Rigshospitalet, and the Lundbeck Foundation had no role in the design and conduct of the study; collection, management, analyses, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© The Author(s) 2024.

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