Long-term outcomes of patients affected by Guillain-Barré syndrome in Colombia after the Zika virus epidemic

Abstract

Background: Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries.

Objective: To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia.

Methods: Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status.

Results: Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age.

Conclusions: This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.

Keywords: Activities of daily living; Guillain-Barré syndrome; Low- and middle-income countries; Neurological rehabilitation; Peripheral nerves; Polyneuropathies; Quality of life; Recovery of function.

Figure 1.

Participant inclusion flowchart.

Figure 2.. Comparison of mRS and GDS at onset and follow-up interview

A. The mean difference between the mRS at onset (median 4.5 [IQR 4–5]) and at follow-up interview (median 1 [IQR 0–2]) and B. the mean difference between the GDS at onset (median 4 [IQR 4–4]) and at follow-up interview (median 2 [IQR 0–3]) are shown in the Gardner-Altman estimation plot(23). The mRS and GDS scores at both times are plotted on the left axis, and the mean difference is plotted on a floating axis on the right as a bootstrap sampling distribution. The mean difference is depicted as a dot, and the ends of the vertical error bar indicate the 95% confidence interval.