Predictors of poor prognosis in Guillain-Barre' syndrome: a study of 22 years from a single Italian Center

Abstract

Background: The clinical course and outcome of the Guillain-Barré syndrome (GBS) are diverse and vary among regions, which complicates the management and evaluation of treatment effects in individual patients.

Objective: To identify predictors of poor prognosis identified by the inability to walk unaided 10 m across an open space (GBS disability score ≥ 3) at 4, 24 and 52 weeks after onset in 230 adults Italian GBS patients, admitted to Neurology Unit, Modena (Italy) during a period of 22 years starting from 2000.

Methods: In this study, 230 patients were collected and analyzed retrospectively. We studied demographic features, clinical presentation, cranial nerve and neck weakness involvement, electrophysiologic phenotype, disease course, associated cardiovascular comorbidities, presence of autonomic dysfunction. The used statistical models were univariable logistic, univariable and multivariable Cox regression analyses.

Results: Older age at onset, weakness of neck muscles and involvement of cranial nerves (CNI), low extremity strength at entry, mechanical ventilation (MV) need, autonomic dysfunction, presence of associated cardiovascular disorders, electrophysiological features of axonal damage, treatment related fluctuations (TRF) were predictors of poor outcome in 230 Italian GBS.

Conclusions: We studied in 230 Italian GBS patients over 22 years the role of main clinical and electrophysiological predictors of poor outcome, which included older age at onset, CNI, neck muscle weakness, low MRCss at entry, dysautonomia, TRF, MV need, features of axonal damage on NCS, associated cardiovascular disorders.

Keywords: Dysautonomia; GBS disability scale; Guillain-Barré syndrome; cardiovascular disorders in GBS; predictors of outcome.