目的:我们的研究旨在研究抗N-甲基-d-天冬氨酸受体(NMDAR)脑炎住院的儿科患者并发精神病的危险因素及其对医院预后的影响。
方法:我们使用全国住院患者样本(NIS2018-2019)进行了一项横断面研究。我们纳入了3,405名儿科住院患者(年龄6-17岁),其主要出院诊断为抗NMDAR脑炎。我们使用二项逻辑回归模型来评估与并发精神病相关的变量(人口统计学和合并症)的比值比(OR)。
结果:在抗NMDAR脑炎住院患者中,共患精神病的患病率为5.3%,主要由青少年(72.2%)和女性(58.3%)组成。在种族方面,黑人(或2.41),与白人相比,西班牙裔(OR1.80)患精神病的风险更高。在合并症中,患有抑郁症的脑炎住院患者(OR4.60),睡眠-觉醒障碍(OR3.16),焦虑症(OR2.11),神经发育障碍(OR1.95),和破坏性行为障碍(OR2.15)有较高的合并症精神病风险。合并精神病的抗NMDAR脑炎住院患者的中位住院时间更长,为24.6天(与9.8天)和更高的中位数费用为262,796美元(而$135,323)与没有精神病表现的人相比。
结论:青少年,女性,患有脑炎的黑人患精神病的风险更高,导致抗NMDAR脑炎住院。人口预测因素和合并症的识别可以帮助早期识别和干预,以优化护理并潜在地减轻医疗负担。
OBJECTIVE: Our study aims to examine the risk factors for comorbid psychosis in pediatric patients hospitalized for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and its impact on hospital outcomes.
METHODS: We conducted a cross-sectional study using the nationwide inpatient sample (NIS 2018-2019). We included 3,405 pediatric inpatients (age 6-17 years) with a primary discharge diagnosis of anti-NMDAR encephalitis. We used binomial logistic regression model to evaluate the odds ratio (OR) of variables (demographic and comorbidities) associated with comorbid psychosis.
RESULTS: The prevalence of comorbid psychosis in anti-NMDAR encephalitis inpatients was 5.3%, and majorly constituted of adolescents (72.2%) and females (58.3%). In terms of race, Blacks (OR 2.41), and Hispanics (OR 1.80) had a higher risk of comorbid psychosis compared to Whites. Among comorbidities, encephalitis inpatients with depressive disorders (OR 4.60), sleep-wake disorders (OR 3.16), anxiety disorders (OR 2.11), neurodevelopmental disorders (OR 1.95), and disruptive behavior disorders (OR 2.15) had a higher risk of comorbid psychosis. Anti-NMDAR encephalitis inpatients with comorbid psychosis had a longer median length of stay at 24.6 days (vs. 9.8 days) and higher median charges at $262,796 (vs. $135,323) compared to those without psychotic presentation.
CONCLUSIONS: Adolescents, females, and Blacks with encephalitis have a higher risk of psychotic presentation leading to hospitalization for anti-NMDAR encephalitis. Identification of demographic predictors and comorbidities can aid in early recognition and intervention to optimize care and potentially reduce the healthcare burden.