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. 2025 Feb;42(1):196-206.
doi: 10.1007/s12028-024-02063-6. Epub 2024 Jul 31.

Development and Validation of a Risk Score for Predicting ICU Admission in Adults with New-Onset Encephalitis

Ralph Habis  1 , Ashley Heck  2 , Paris Bean  2 , John Probasco  1 , Romergryko G Geocadin  1   3 , Rodrigo Hasbun  2 , Arun Venkatesan  4
Affiliations

Development and Validation of a Risk Score for Predicting ICU Admission in Adults with New-Onset Encephalitis

Ralph Habis et al. Neurocrit Care. 2025 Feb.

Abstract

Background: Timely intensive care unit (ICU) admission for patients with encephalitis is associated with better prognosis. Therefore, our aim was to create a risk score predicting ICU admission in adults with encephalitis, which could aid in optimal management and resource allocation.

Methods: We initially identified variables that would be most predictive of ICU admission among 372 patients with encephalitis from two hospital systems in Houston, Texas (cohort 1), who met the International Encephalitis Consortium (IEC) criteria from 2005 to 2023. Subsequently, we used a binary logistic regression model to create a risk score for ICU admission, which we then validated externally using a separate cohort of patients from two hospitals in Baltimore, Maryland (cohort 2), who met the IEC criteria from 2006 to 2022.

Results: Of 634 patients with encephalitis, 255 (40%) were admitted to the ICU, including 45 of 113 (39.8%) patients with an autoimmune cause, 100 of 272 (36.7%) with an infectious cause, and 110 of 249 (44.1%) with an unknown cause (p = 0.225). After conducting a multivariate analysis in cohort 1, we found that the presence of focal neurological signs, new-onset seizure, a Full Outline of Unresponsiveness score ≤ 14, leukocytosis, and a history of chronic kidney disease at admission were associated with an increased risk of ICU admission. The resultant clinical score for predicting ICU admission had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95% confidence interval [CI] 0.72-0.82, p < 0.001). Patients were classified into three risk categories for ICU admission: low risk (score 0, 12.5%), intermediate risk (scores 1-5, 49.5%), and high risk (scores 6-8, 87.5%). External validation in cohort 2 yielded an AUROC of 0.76 (95% CI 0.69-0.83, p < 0.001).

Conclusions: ICU admission is common in patients with encephalitis, regardless of etiology. Our risk score, encompassing neurologic and systemic factors, may aid physicians in decisions regarding intensity of care for adult patients with encephalitis upon hospital admission.

Keywords: Clinical prediction rules; Critical care outcomes; Encephalitis; Prognosis; Risk assessment.

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Conflict of interest statement

Conflicts of interest: Rodrigo Hasbun receives research support and personal fees from BioFire Diagnostics. John Probasco receives personal compensation for activity as Editor-in-Chief of The New England Journal of Medicine Journal Watch Neurology and serves as site investigator for a treatment trial for autoimmune encephalitis sponsored by Genentech. Ralph Habis serves as study coordinator for a treatment trial for autoimmune encephalitis sponsored by Genentech. The other authors declare no conflicts of interest. Ethical Approval/Informed Consent: This study was performed in line with the principles of the Declaration of Helsinki and was approved by the University of Texas and the Johns Hopkins School of Medicine Institutional Review Boards (IRB) (“Aseptic Meningoencephalitis in adults and children,” HSC-MS-08-0417, approval 05/11/2023; “Establishment of an encephalitis and seizure repository and database” IRB00083718, approval 11/30/2015; “Infectious and autoimmune encephalitis: a chart review” IRB00214450, approval 10/26/2021). The need for patient consent was waived by both IRBs.

References

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