Early differentiation of viral encephalitis and autoimmune encephalitis by clinical and basic laboratory data

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Background and Objectives Timely differentiation between autoimmune and viral causes of encephalitis is critical for guiding disease-specific treatment. This study aimed to develop a scoring system to facilitate early (< 6 h after presentation) differentiation between viral encephalitis (VE) and autoimmune encephalitis (AE). Methods We performed a retrospective, single-center analysis of all patients diagnosed with encephalitis for any etiology at the University Hospital Regensburg between January 1st, 2004 and December 31st, 2020. Based on patient history, clinical findings, and cerebrospinal fluid (CSF) parameters, we developed a scoring system to differentiate between VE and AE. Results A total of 434 cases with encephalitis were included, of which 171 had Herpes simplex virus encephalitis, V aricella zoster virus encephalitis, tick-borne encephalitis or autoimmune encephalitis. Based on a homogeneous subgroup of 108 cases of VE and 44 cases of AE, we used a logistic regression model to derive a score including fever, headache, CSF white blood cell count, CSF lactate concentration, and CSF protein concentration for early differentiation. The score showed very good discrimination (AUC 0.94, 95% confidence interval (CI): 0.90–0.99), with a specificity of 87.0% and sensitivity of 88.6% in our cohort. Discussion and conclusion Our scoring system might help to identify patients with VE or AE at presentation. Further validation is needed.