Abstract
OBJECTIVE: To systematically evaluate the efficacy and safety of blood purification in the treatment of autoimmune encephalitis (AE). METHODS: Databases including PubMed, Embase, and Cochrane Library were systematically searched. Prospective and retrospective cohort studies were included. Data on patients' baseline characteristics, interventions, and outcomes were extracted. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of included studies. Meta-analysis was performed using RevMan 5.4 software. RESULTS: Fifteen studies (531 patients) were included; NOS scores of 7-9 indicated high quality. Efficacy analysis showed that in studies with control groups, blood purification significantly increased the likelihood of clinical improvement (Odds Ratio (OR)=5.61, 95% Confidence Interval (CI) [2.72, 11.56], P<0.00001). In studies without control groups, most efficacy indicators (e.g., clinical improvement, modified Rankin Scale (mRS) score improvement) showed statistical significance. Safety analysis revealed that the risk of therapeutic plasma exchange (TPE)-related adverse events was significantly increased (Risk Difference (RD)=0.46, 95% CI [0.40, 0.52], P<0.00001). The risks of complications and seizures were also elevated (RD=0.57 and 0.74, respectively, both P<0.05). The risk of total adverse reactions per cycle was increased (RD=0.09, 95% CI [0.04, 0.14], P=0.0004). The 1-year relapse risk was significantly increased (RD=0.07, 95% CI [0.02, 0.11], P=0.004), while there was no significant difference in mortality (P>0.05). Publication bias was assessed via funnel plots and Egger's test, with no evidence of bias, and sensitivity analysis results were stable. CONCLUSION: Blood purification can significantly improve clinical outcomes in AE patients, but it is associated with higher risks of adverse events and relapse.