Assessment of clinical prognosis in autoimmune encephalitis: Girona score.

Abstract

Background: The assessment of clinical prognosis in autoimmune encephalitis: Girona (ACPE-Gi) score is a scale for evaluating the severity in the acute phase of autoimmune encephalitis (AE) and predicting the risk of disability at 3 months, measured by modified Rankin scale (mRS).

Methods: Patients were strictly diagnosed with AE according to the current criteria between 1 January 2009 to 31 March 2023 at the University Hospital Dr. Josep Trueta of Girona, Catalonia, Spain. ACPE-Gi score included 14 items, and every item was scored from 0 to 3, depending on their severity with a sum ranging from 0 to 41.

Results: ACPE-Gi score measured the severity in the acute phase and grouped the patients into three groups: mild (<8; 32%), moderate (8 to 15; 60%), and severe (>15; 8%). We found that the third group had a higher risk of disability compared with the first group (p = 0.035). We identified that the mean initial score was significantly higher in the group of patients who had higher mRS at 3 months compared to that in the group of patients who had a mild to moderate disability level (mRS ≤ 2) at 3 months (p = 0.023). In addition, autonomic symptoms and mental status impairment demonstrated to be independent risk factors to predict disability (p < 0.05).

Conclusions: The ACPE-Gi score seems to be a reliable scale for comprehensively evaluating the severity of AE in the acute phase and predicting the risk of disability at 3 months. Dysautonomia and altered mental status predict a poorer prognosis in patients with AE.