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@ARTICLE{Preler:285465,
author = {Preßler, Hannah and Schwarz, Lisa and Streit, Simon and
Aigner, Annette and Schleicher, Alicia and Stascheit, Frauke
and Arlt, Friederike A and Zinnow, Viktoria and Khorassani,
Tatjana and Prüss, Harald and Böhmerle, Wolfgang and
Meisel, Andreas and Stenzel, Werner and Scheibe, Franziska},
title = {{C}linical course and prognosis of chronic autoimmune
neuropathies requiring intensive care: a retrospective
cohort study.},
journal = {Journal of neurology},
volume = {273},
number = {2},
issn = {0367-004X},
address = {[Darmstadt]},
publisher = {Steinkopff},
reportid = {DZNE-2026-00243},
pages = {165},
year = {2026},
abstract = {Data on chronic autoimmune neuropathies (CAN) requiring
intensive care unit (ICU) treatment are limited. This study
investigated clinical and neuropathological features,
immunotherapies, and outcomes of ICU-treated CAN
patients.Retrospectively, we analyzed patients with CAN
admitted to the ICU between 2007 and 2024. Outcomes,
assessed by Inflammatory Neuropathy Cause and Treatment
(INCAT) score and modified Rankin scale (mRS), were compared
to age, sex, and diagnosis-matched non-ICU outpatients using
ordinal and binary logistic regression.Among 21 included
patients (chronic inflammatory demyelinating neuropathies
(CIDP): n = 15, other CAN: n = 6), $95\%$ required
mechanical ventilation and exhibited severe tetraparesis at
disease nadir. Biopsies from CIDP patients revealed
moderate-to-severe chronic axonal loss with variable CD8 +
T-cell infiltration (9/11), and complement deposition
(C5b-9) was detected in all samples (n = 8/8). All patients
received first-line immunotherapy at ICU, $62\%$ required
'escalation' (rituximab: n = 13, cyclophosphamide: n = 3).
Five $(24\%)$ remained refractory, receiving daratumumab (n
= 3), efgartigimod (n = 1), or autologous stem cell
transplantation (n = 1). Six patients $(29\%)$ died, whereas
survivors showed marked improvement with median change of -
2 mRS points $(95\%$ CI - 5 to - 2) and - 6 INCAT points
$(95\%$ CI - 8 to- 5) at last follow-up. However,
ICU-treated patients had significantly higher odds of worse
long-term outcomes than matched non-ICU patients (adjusted
cumulative OR: mRS 7.1 $95\%$ CI 1.9-27.3, INCAT 6.4 $95\%$
CI 1.7-23.2).Severe CAN requiring ICU treatment is
associated with high mortality, but meaningful recovery is
possible in survivors. Neuropathology confirmed combined
cellular and humoral mechanisms, supporting personalized,
mechanism-guided therapeutic approaches.},
keywords = {Humans / Male / Female / Retrospective Studies / Middle
Aged / Aged / Prognosis / Critical Care / Adult /
Polyradiculoneuropathy, Chronic Inflammatory Demyelinating:
therapy / Polyradiculoneuropathy, Chronic Inflammatory
Demyelinating: diagnosis / Polyradiculoneuropathy, Chronic
Inflammatory Demyelinating: pathology / Immunotherapy /
Intensive Care Units / Autoimmune Diseases of the Nervous
System: therapy / Autoimmune Diseases of the Nervous System:
diagnosis / Autologous stem cell transplantation (Other) /
Chronic autoimmune neuropathies (Other) / Daratumumab
(Other) / Intensive care unit (Other)},
cin = {AG Prüß},
ddc = {610},
cid = {I:(DE-2719)1810003},
pnm = {353 - Clinical and Health Care Research (POF4-353)},
pid = {G:(DE-HGF)POF4-353},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:41739210},
pmc = {pmc:PMC12935830},
doi = {10.1007/s00415-026-13694-4},
url = {https://pub.dzne.de/record/285465},
}