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Meta-Analysis
. 2021 Oct;28(10):3517-3529.
doi: 10.1111/ene.14860. Epub 2021 Apr 28.

Prevalence, clinical characteristics and outcomes of Guillain-Barré syndrome spectrum associated with COVID-19: A systematic review and meta-analysis

Lina Palaiodimou  1 , Maria-Ioanna Stefanou  1 , Aristeidis H Katsanos  1   2 , Paraskevi C Fragkou  3 , Marianna Papadopoulou  1   4 , Christos Moschovos  1 , Ioannis Michopoulos  5 , Panagiotis Kokotis  6 , Christos Bakirtzis  7 , Androniki Naska  8 , Theodoros I Vassilakopoulos  9 , Elisabeth Chroni  10 , Sotirios Tsiodras  3   11 , Georgios Tsivgoulis  1   12
Affiliations
Meta-Analysis

Prevalence, clinical characteristics and outcomes of Guillain-Barré syndrome spectrum associated with COVID-19: A systematic review and meta-analysis

Lina Palaiodimou et al. Eur J Neurol. 2021 Oct.

Abstract

Background and purpose: Mounting evidence supports an association between Guillain-Barré syndrome spectrum (GBSs) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, GBSs in the setting of coronavirus disease 2019 (COVID-19) remains poorly characterized, whilst GBSs prevalence amongst COVID-19 patients has not been previously systematically evaluated using a meta-analytical approach.

Methods: A systematic review and meta-analysis of observational cohort and case series studies reporting on the occurrence, clinical characteristics and outcomes of patients with COVID-19-associated GBSs was performed. A random-effects model was used to calculate pooled estimates and odds ratios (ORs) with corresponding 95% confidence intervals (CIs), compared to non-COVID-19, contemporary or historical GBSs patients.

Results: Eighteen eligible studies (11 cohorts, seven case series) were identified including a total of 136,746 COVID-19 patients. Amongst COVID-19 patients, including hospitalized and non-hospitalized cases, the pooled GBSs prevalence was 0.15‰ (95% CI 0%-0.49‰; I2 = 96%). Compared with non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds for demyelinating GBSs subtypes (OR 3.27, 95% CI 1.32%-8.09%; I2 = 0%). In SARS-CoV-2-infected patients, olfactory or concomitant cranial nerve involvement was noted in 41.4% (95% CI 3.5%-60.4%; I2 = 46%) and 42.8% (95% CI 32.8%-53%; I2 = 0%) of the patients, respectively. Clinical outcomes including in-hospital mortality were comparable between COVID-19 GBSs patients and non-infected contemporary or historical GBSs controls.

Conclusion: GBSs prevalence was estimated at 15 cases per 100,000 SARS-CoV-2 infections. COVID-19 appears to be associated with an increased likelihood of GBSs and with demyelinating GBSs variants in particular.

Keywords: COVID-19; Guillain−Barré syndrome; acute inflammatory demyelinating polyneuropathy; mortality; prevalence.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Flow chart presenting the selection of eligible studies
FIGURE 2
FIGURE 2
Pooled analysis on the prevalence of Guillain−Barré syndrome spectrum cases amongst COVID‐19 patients (a), COVID‐19‐associated general hospital admissions (b) and COVID‐19‐associated neurological admissions (c) [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Pooled prevalence of acute inflammatory demyelinating polyneuropathy subtype amongst COVID‐19‐associated Guillain−Barré syndrome spectrum cases, stratified by study design (a) and probability of acute inflammatory demyelinating polyneuropathy subtype in COVID‐19‐associated Guillain−Barré syndrome spectrum cases compared to contemporary or historical controls (b) [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Pooled in‐hospital mortality rate amongst COVID‐19‐associated Guillain−Barré syndrome spectrum cases, stratified by study design (a) and probability of in‐hospital mortality amongst COVID‐19‐associated Guillain−Barré syndrome spectrum cases compared to contemporary or historical controls (b) [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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