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Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome
Xiujuan Wu1, Chunrong Li2, Bing Zhang3
1Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China. wuxiujuan861003@126.com.
Introduction:
Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system. Respiratory failure requiring mechanical ventilation (MV) is a serious complication of GBS. Identification of modifiable risk factors for MV and poor short-term prognosis in mechanically ventilated patients with GBS may contribute to the individualized management and may help improve the outcome of the patients.
Methods:
We retrospectively analyzed the clinical data of 541 patients who were diagnosed with GBS from 2003 to 2014. Independent predictors for MV and short-term prognosis in mechanically ventilated patients were identified via multivariate logistic regression analysis.
Results:
The mean age was 41.6 years with a male predilection (61.2%). Eighty patients (14.8%) required MV. Multivariate analysis revealed that shorter interval from onset to admission (p < 0.05), facial nerve palsy (p < 0.01), glossopharyngeal and vagal nerve deficits (p < 0.01) and lower Medical Research Council (MRC) sum score at nadir (p < 0.01) were risk factors for MV; disease occurrence in summer (p < 0.01) was a protective factor. As to prognostic factors, absence of antecedent infections (p < 0.01) and lower MRC sum score at nadir (p < 0.01) were predictors of poor short-term prognosis in mechanically ventilated patients regardless of treatment modality. We further investigated the predictors of poor short-term prognosis in patients requiring MV with different nadir MRC sum scores. Combined use of intravenous corticosteroids with intravenous immunoglobulin (odds ratio 10.200, 95% confidence interval 1.068-97.407, p < 0.05) was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection.
Conclusions:
Clinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct. Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.
Insights
Guillain-Barré syndrome (GBS) patients requiring mechanical ventilation (MV) have distinct risk factors for MV and poor prognosis. Combined corticosteroid and immunoglobulin therapy predicted poor outcomes in severe GBS cases.
Area of Science:
- Neurology
- Immunology
- Critical Care Medicine
Background:
- Guillain-Barré syndrome (GBS) is an immune-mediated peripheral nervous system disorder.
- Respiratory failure necessitating mechanical ventilation (MV) is a critical GBS complication.
- Identifying modifiable risk factors for MV and poor prognosis in GBS is crucial for patient management.
Purpose of the Study:
- To identify independent predictors for mechanical ventilation (MV) in GBS patients.
- To determine factors associated with poor short-term prognosis in mechanically ventilated GBS patients.
- To investigate the impact of treatment modalities on prognosis in severe GBS cases.
Main Methods:
- Retrospective analysis of clinical data from 541 GBS patients (2003-2014).
- Multivariate logistic regression used to identify independent predictors for MV and prognosis.
- Analysis stratified by nadir Medical Research Council (MRC) sum score for prognostication.
Main Results:
- Risk factors for MV included shorter onset-to-admission interval, facial nerve palsy, cranial nerve deficits, and lower MRC sum score; summer disease onset was protective.
- Absence of antecedent infections and lower MRC sum score predicted poor short-term prognosis in MV patients.
- Combined intravenous corticosteroids and immunoglobulin therapy predicted poor prognosis in MV patients with MRC sum scores of 0-12.
Conclusions:
- Clinical predictors for MV and poor short-term prognosis in GBS patients are distinct.
- Add-on intravenous corticosteroids pose a risk for poor prognosis in mechanically ventilated GBS patients with severe muscle weakness (MRC sum score 0-12).
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