Early differentiation of viral encephalitis and autoimmune encephalitis by clinical and basic laboratory data.

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Frontiers in Neurology Pub Date : 2026-10-13 eCollection Date: 2026-01-01 DOI:10.3389/fneur.2026.1827372

Tim Steinberg, Andreas Hierl, David Freudenstein, De-Hyung Lee, Ralf A Linker, Markus Bauswein, Hendrik Hartmann, Barbara Schmidt, Klemens Angstwurm

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引用次数: 0

Abstract

Background and objectives: Timely differentiation between autoimmune and viral causes of encephalitis is critical for guiding disease-specific treatment. This study aimed to develop a scoring system to facilitate early (< 6 h after presentation) differentiation between viral encephalitis (VE) and autoimmune encephalitis (AE).

Methods: We performed a retrospective, single-center analysis of all patients diagnosed with encephalitis for any etiology at the University Hospital Regensburg between January 1st, 2004 and December 31st, 2020. Based on patient history, clinical findings, and cerebrospinal fluid (CSF) parameters, we developed a scoring system to differentiate between VE and AE.

Results: A total of 434 cases with encephalitis were included, of which 171 had Herpes simplex virus encephalitis, Varicella zoster virus encephalitis, tick-borne encephalitis or autoimmune encephalitis. Based on a homogeneous subgroup of 108 cases of VE and 44 cases of AE, we used a logistic regression model to derive a score including fever, headache, CSF white blood cell count, CSF lactate concentration, and CSF protein concentration for early differentiation. The score showed very good discrimination (AUC 0.94, 95% confidence interval (CI): 0.90-0.99), with a specificity of 87.0% and sensitivity of 88.6% in our cohort.

Discussion and conclusion: Our scoring system might help to identify patients with VE or AE at presentation. Further validation is needed.

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病毒性脑炎和自身免疫性脑炎的临床和实验室基础资料早期鉴别。

背景和目的：及时区分自身免疫性和病毒性脑炎病因对指导疾病特异性治疗至关重要。本研究旨在建立一个评分系统，以促进早期（发病后< 6小时）区分病毒性脑炎（VE）和自身免疫性脑炎（AE）。方法：我们对2004年1月1日至2020年12月31日期间在雷根斯堡大学医院诊断为脑炎的所有患者进行了回顾性单中心分析。根据患者病史、临床表现和脑脊液（CSF）参数，我们开发了一个评分系统来区分VE和AE。结果：共纳入434例脑炎，其中单纯疱疹病毒性脑炎、水痘带状疱疹病毒性脑炎、蜱传性脑炎和自身免疫性脑炎各171例。基于108例VE和44例AE的同质亚组，我们使用logistic回归模型得出包括发热、头痛、脑脊液白细胞计数、脑脊液乳酸浓度和脑脊液蛋白浓度的早期分化评分。该评分具有很好的鉴别性（AUC 0.94, 95%可信区间（CI）： 0.90-0.99），在我们的队列中特异性为87.0%，敏感性为88.6%。讨论和结论：我们的评分系统可能有助于在就诊时识别VE或AE患者。需要进一步验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Neurology CLINICAL NEUROLOGYNEUROSCIENCES -NEUROSCIENCES

CiteScore

4.90

自引率

8.80%

发文量

2792

审稿时长

14 weeks

期刊介绍： The section Stroke aims to quickly and accurately publish important experimental, translational and clinical studies, and reviews that contribute to the knowledge of stroke, its causes, manifestations, diagnosis, and management.