Risk factors for the severity of Guillain-Barré syndrome and predictors of short-term prognosis of severe Guillain-Barré syndrome

Abstract

Guillain-Barré syndrome (GBS) is a neurological disorder characterized by paralysis. Identifying the severity, appropriate therapeutic method, and prognosis of GBS at an early stage is highly important. This study aimed to investigate the modifiable risk factors for the severity of GBS and consequent need for mechanical ventilation (MV) and to identify clinical predictive factors for poor short-term outcomes of severe GBS. 155 GBS patients who were admitted to the Affiliated Yantai Yuhuangding Hospital of Qingdao University during 2014-2020 were enrolled. Demographic, clinical, therapeutic and evolutionary data were collected and were then analyzed using univariate and multivariate regression analyses. Our analytic data demonstrated that the significant clinical predictors of severe GBS were recent history of surgery, older age, cranial nerve impairment, and elevated levels of liver enzymes (p < 0.05). Furthermore, autonomic dysfunction, lower Medical Research Council (MRC) score at nadir, and elevated levels of liver enzymes were significantly associated with MV for severe GBS (p < 0.05), and lower MRC score at nadir and autonomic dysfunction remained significant predictors of MV in severe GBS (p < 0.05). Lastly, recent history of surgery, lower MRC score at admission and at nadir, requirement for MV, and pneumonia during hospitalization were significantly associated with the short-term outcome of severe GBS and that lower MRC score at admission and need for MV were confirmed to be predictors of poor short-term prognosis (p < 0.05). Of note, this study suggested that recent history of surgery is a predictor of severity in GBS patients and is associated with the poor short-term prognosis of severe GBS.

Figure 1

Comparisons between severe GBS group and non-severe GBS group. (a) MRC at admission and MRC at nadir in severe GBS group were both lower than non-severe GBS group (both p < 0.05). (b) In severe GBS group, recent history of surgery, elevated liver enzyme, cranial nerve involvement and autonomic dysfunction were totally higher than non-severe GBS group(p < 0.05).

Figure 2

Comparisons between Group MV and Group NV, Subgroup 1 and Subgroup 2. (a) MRC at nadir in Group MV were lower than Group NV (p < 0.05), but MRC at admission had no difference between Group MV and Group NV in statistic. (b) In Subgroup 1, MRC at admission and at nadir were both higher than Subgroup 2(both p < 0.05). (c) Recent history of surgery, requiring MV and complicated by pneumonia were totally lower in Subgroup 1 than Subgroup 2(p < 0.05).