Clinical and Laboratory Predictors of Poor Neurological Outcomes Following Infectious Encephalitis: Systematic Review and Meta‐Analysis

Journal article : Review

Background and Objectives: Infectious encephalitis is a serious global health problem linked to high rates of mortality and morbidity. However, clinical and laboratory factors that impact neurological outcomes following infectious encephalitis remain poorly understood. Accordingly, we undertook a systematic review and meta‐analysis of clinical and laboratory factors influencing neurological outcomes following infectious encephalitis. Methods: We searched MEDLINE and EMBASE from inception to 25th September 2023 for observational studies that reported on neurological outcomes at discharge or at ≥ 6 months. We assessed the prognostic value of a priori selected clinical and laboratory‐based features by estimating pooled risk ratios (RRs) through a random‐effects meta‐analysis. The I2 statistic was used to assess heterogeneity. This study is registered with PROSPERO (CRD42023485045). Results: There were several key findings. First, immunocompromised status, status epilepticus, and Glasgow coma scale of < 8 during initial admission were significantly associated with poor neurological outcomes both at discharge and ≥ 6 months after infectious encephalitis onset. Second, CSF leucocytosis [RR: 0.83 95% CI: 0.69–0.98, p = 0.03, n = 5, I2 = 0%] conferred better neurological outcomes while elevated CSF protein [RR: 1.25 95% CI: 1.07–1.46, p = 0.006, n = 7, I2 = 0%] was linked to worse neurological outcomes at discharge. Third, there was no significant association between adjunct steroid therapy and neurological outcomes at discharge and ≥ 6 months. Discussion: This is the first systematic review and meta‐analysis to investigate prognostic factors linked to neurological outcomes following infectious encephalitis. The results highlight the prognostic value of a range of easily accessible clinical and laboratory parameters.

Authors: Johnson, T; Venables, M; Soleimani, B; Havins, L; Kannan, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: European Journal of Neurology
• Volume: 32
• Issue: 12
• Article number: e70445
• Publication date: 2025-11-26
• Acceptance date: 2025-11-06
• DOI: 10.1111/ene.70445
• EISSN: 1468-1331
• ISSN: 1351-5101
• Language: English
• Keywords: infection; encephalitis; outcomes; prognostic; neurological
• Subtype: Review