Risk factors screening of acute symptomatic seizure secondary to anti⁃ N ⁃ methyl ⁃ D ⁃ aspartate receptor encephalitis based on Nomogram model

Abstract

Objective To investigate the risk factors of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis with acute symptomatic seizure (ASS), and establish a Nomogram model based on clinical indicators. Methods A retrospective analysis was performed on 84 patients with anti-NMDAR encephalitis who were diagnosed in Beijing Tiantan Hospital, Capital Medical University from May 2012 to October 2020. Univariate and multivariate Logistic regression analyses were used to determine the risk factors of anti-NMDAR encephalitis with ASS, and a Nomogram model was constructed. The receiver operating characteristic (ROC) curve and calibration curve of the model were plotted, and Hosmer-Lemeshow goodness of fit test was performed. Results In all 84 patients, 63 cases (75%) presented with ASS, and 35 cases (41.67%) had ASS as the initial symptom. Logistic regression analysis showed male (OR = 7.680, 95%CI: 1.811-32.562; P = 0.006), psychosis and abnormal behavior (OR = 6.486, 95%CI: 1.818-23.141; P = 0.004), anti ⁃ NMDAR antibody titer in cerebrospinal fluid (CSF) ≥ 1∶32 (OR = 9.322, 95%CI: 2.132-40.766; P = 0.003) were the risk factors of anti⁃NMDAR encephalitis with ASS, older age was the protective factor (OR = 0.942, 95%CI: 0.903-0.983; P = 0.006). A Nomogram model was established based on the 4 risk factors, and the area under curve (AUC) of ROC was 0.862 (95%CI: 0.776-0.949, P = 0.000). Calibration curve showed a good agreement between the predicted probability and the actual probability of ASS occurrence, and Hosmer ⁃ Lemeshow test showed there was no statistical difference (χ² = 4.318, P = 0.827). Conclusions Male, young age, psychosis and abnormal behavior, and anti ⁃ NMDAR antibody titer in CSF ≥ 1∶32 are more likely to have ASS in patients with anti ⁃NMDAR encephalitis. This Nomogram model constructed based on the above 4 indicators may accurately and conveniently predict ASS and provide a reference for clinical diagnosis and treatment.

doi：10.3969/j.issn.1672⁃6731.2022.03.010