Prognostic and Clinical Significance of Hypoglycorrhachia in Adults with Encephalitis
Sienna Wu1, Rodrigo Hasbun1, Arun Venkatesan2, John Probasco2, Laya Rao1, Paris Bean1, Ralph Habis3, Ashley Heck1, Rajesh Gupta1
1UTHealth Houston, 2Johns Hopkins Hospital, 3Johns Hopkins School of Medicine
Objective:
The aim was to determine the clinical and prognostic significance of hypoglycorrhachia in encephalitis.
Background:
Encephalitis is an inflammation of the brain caused by several infectious or non-infectious etiologies (e.g., autoimmune encephalitis) that can lead to neurological complications and death. Hypoglycorrhachia (cerebrospinal fluid glucose level < 45 mg/dl) is associated with worse clinical outcomes in meningitis.
Design/Methods:
We conducted an IRB-approved, retrospective chart review of patients diagnosed with encephalitis from Greater Houston and Greater Baltimore regions between 2005 and 2022 based on the 2013 International Encephalitis Consortium inclusion criteria. We collected data on demographic features, presenting symptoms, imaging findings, and clinical outcomes. A bivariate analysis was used to analyze dichotomous clinical features by performing a chi-square test and utilizing Pearson Chi Square and Fisher Exact Test values. Descriptive statistics were also used, including median for continuous variables.
Results:
Of the 614 patients enrolled in this study (32% viral, 18% autoimmune, 50% unclear/other etiology), 17.8% had hypoglycorrhachia (n=109). Patients with hypoglycorrhachia were significantly more likely to be immunocompromised and HIV positive, as well as present with higher rates of fever, headache, neck stiffness, and leukocytosis (p<0.05). Hypoglycorrhachia was significantly less likely to present with seizures, memory deficits, and psychiatric symptoms (p<0.05). Patients with hypoglycorrhachia were statistically less likely to have encephalitis of an autoimmune etiology (4.5% vs 16.5%, p<.001). Hypoglycorrhachia was also more likely to present with abnormal CT imaging (31.5% vs 20.7%, p=.032). Patients with hypoglycorrhachia were less likely to die (p<.001) and have adverse clinical outcomes as defined by the Glasgow Outcome Scale (p=.015).
Conclusions:
Hypoglycorrhachia was seen more commonly in immunocompromised hosts with abnormal cranial imaging and less likely in autoimmune encephalitis. In contrast to meningitis, hypoglycorrhachia was associated with better patient outcomes.