Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome

Abstract

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.

Fig. 1

Comparisons between patients with and without mechanical ventilation. a The seasonal distribution in GBS occurrence was different between Group MV and Group NV. More GBS patients with mechanical ventilation were found in winter, while those without mechanical ventilation were more common in summer (both p < 0.05). b Time from onset to admission and time from onset to nadir were both shorter in Group MV (3.5 versus 6.3 and 5.9 versus 7.6; both p < 0.05). As assessed by c the MRC sum score and d HFGS, more severe disease severity was found in Group MV (MRC, 16.6 versus 41.0; HFGS, 5 versus 3.0; both p < 0.05). Group MV GBS patients with mechanical ventilation, Group NV GBS patients did not require mechanical ventilation, HFGS Hughes Functional Grading Scale, MRC Medical Research Council (sum score)

Fig. 2

Comparisons of mechanically ventilated patients with good and poor short-term prognoses. a Seasonal distribution in the mechanically ventilated GBS patients with good short-term prognosis (Subgroup 1) was similar to that in the poor-short-term prognosis (Subgroup 2) (spring, 32.4 % versus 20 %; summer, 17.6 % versus 30 %; autumn, 20.6 % versus 30 %; winter, 29.4 % versus 20 %; all p > 0.05). b Time from onset to admission (3.5 versus 3.6, p > 0.05) and time from onset to nadir (5.8 versus 6.2, p > 0.05) were not significantly different. c MRC at nadir was significantly lower in the poor short-term prognosis group compared with the good short-term prognosis group (26.9 versus 7.4, p < 0.05). d As the infection complications during hospitalization were related to the prognosis of patients, we further compared the incidence of complications and found it was similar between two groups (85.3 % versus 92.5 %, p > 0.05). MRC Medical Research Council (sum score)

Fig. 3

Distribution of mechanically ventilated patients with different nadir MRC sum scores. There were 40 patients with a nadir MRC sum score from 0 to 12 points, corresponding to muscle strength less than 1/5 grade. In addition, 12 patients with a nadir MRC sum score from 13 to 24 points, 13 with a nadir MRC sum score from 25 to 36 points, 5 with a nadir MRC sum score from 37 to 48 points, and 4 with a nadir MRC sum score from 49 to 60 points