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Published on: October 16, 2013
A novel prognostic system based on clinical and laboratory parameters for childhood Guillain-Barre syndrome
Ishita Tiwari1, Areesha Alam2, Chandra Kanta1
1Departments of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
Aim:
To develop a score based on clinical and laboratory parameters in acute-phase of GBS to predict outcome at 6 months.
Methods:
Clinical and laboratory assessment at admission including blood neutrophil-to-lymphocyte ratio (NLR), pre and post-immunotherapy serum albumin was prospectively performed in pediatric-GBS cases at a tertiary-care hospital over 1 year. Clinical features and laboratory test results were compared between children with complete (Hughes Disability Score; HDS ≤ 1) and incomplete recovery (HDS > 1) at 6 months from onset, using univariate and multivariate analysis. Area-under-receiver-operating-characteristic-curve (AUC) of predictors of prognosis and their optimal cutoffs were assessed.
Results:
Forty-six patients were enrolled (mean age 69.1 ± 35.2 months; male 57.6%). Factors on admission that independently predicted poor-outcome at 6 months were older age, feeble voice, lower NLR and lower post-immunotherapy serum albumin. AUCs and optimal cutoffs of NLR and post-immunotherapy serum albumin for predicting disability at 6 months were 0.729, 0.781 and ≤ 1.65, ≤ 34.5 g/L, respectively. AUCs of clinical parameters such as older age and feeble voice were 0.749 and 0.713 respectively. King GBS outcomescore including all predictors had maximum AUC of 0.971 (95% CI 0.921-1.02). The score at cutoff ≥ 3 demonstrated excellent sensitivity (92.3%) and specificity (96.7%) to determine poor outcome.
Conclusions:
This new prognostic system may be beneficial in recognising children-at-risk of poor prognosis who may benefit from additional treatment.
