Clinical predictors and electrodiagnostic characteristics in patients with Guillain-Barré syndrome with respiratory failure: a retrospective, matched case-control study

Charoentanyarak, Kanchana; Singjam, Apiradee; Saengsuwan, Jiamjit

doi:10.7717/peerj.12930

Cited by 1 publication

(3 citation statements)

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“…Rationale : The body of evidence was downgraded for risk of bias, with various studies demonstrating potential bias in the QUIPS domains of study attrition, prognostic factor measurement, outcome measurement, and statistical analysis and reporting, rendering most studies with overall moderate risk of bias. The body of evidence was further limited by indirectness and imprecision but had overall consistency of the association of bulbar weakness with the need for mechanical ventilation [ 37 – 47 ]. Imprecision was due to large confidence intervals, and indirectness was due to the variable definition of “bulbar weakness” with assessment of either individual, some, or all cranial nerves in several of the included studies.…”

Section: Methodsmentioning

confidence: 99%

“…One study did not find an association of the degree of motor weakness with the need for mechanical ventilation; however, in this study, only 14% received standard-of-care treatment for GBS [ 49 ]. An additional important consideration for use of the degree of motor weakness as a predictor is that different studies assessed the degree of motor weakness variably, both in point of time—including on admission [ 38 , 44 , 47 ] or during the acute phase at disease nadir [ 43 , 50 , 51 ] or not further specified [ 45 , 52 ]—and with variable assessment tools, either by the MRC sum score or the MRC grading scale (score of 1–5) [ 44 , 52 ]. Furthermore, the degree of weakness was categorized differently, with various groups of MRC sum score strength or lack of antigravity strength of various muscle groups.…”

Section: Methodsmentioning

confidence: 99%

“…For example, in some studies, the MRC sum scores were categorized as 0–20, 21–40, and 41–60 [ 45 ], and there were different average MRC scores for admission (around 30) versus during nadir (MRC sum score < 20) [ 53 ]. Similarly, limb strength assessment may focus on both upper and lower extremity limbs or select major muscle groups [ 47 , 54 ]. Different evaluations all agreed on association of higher degree of weakness with risk of respiratory failure.…”

Section: Methodsmentioning

confidence: 99%

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Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome

et al. 2023

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Background Guillain–Barré syndrome (GBS) often carries a favorable prognosis. Of adult patients with GBS, 10–30% require mechanical ventilation during the acute phase of the disease. After the acute phase, the focus shifts to restoration of motor strength, ambulation, and neurological function, with variable speed and degree of recovery. The objective of these guidelines is to provide recommendations on the reliability of select clinical predictors that serve as the basis of neuroprognostication and provide guidance to clinicians counseling adult patients with GBS and/or their surrogates. Methods A narrative systematic review was completed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Candidate predictors, including clinical variables and prediction models, were selected based on clinical relevance and presence of appropriate body of evidence. The Population/Intervention/Comparator/Outcome/Time frame/Setting (PICOTS) question was framed as follows: “When counseling patients or surrogates of critically ill patients with Guillain–Barré syndrome, should [predictor, with time of assessment if appropriate] be considered a reliable predictor of [outcome, with time frame of assessment]?” Additional full-text screening criteria were used to exclude small and lower quality studies. Following construction of an evidence profile and summary of findings, recommendations were based on four GRADE criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use. In addition, good practice recommendations addressed essential principles of neuroprognostication that could not be framed in PICOTS format. Results Eight candidate clinical variables and six prediction models were selected. A total of 45 articles met our eligibility criteria to guide recommendations. We recommend bulbar weakness (the degree of motor weakness at disease nadir) and the Erasmus GBS Respiratory Insufficiency Score as moderately reliable for prediction of the need for mechanical ventilation. The Erasmus GBS Outcome Score (EGOS) and modified EGOS were identified as moderately reliable predictors of independent ambulation at 3 months and beyond. Good practice recommendations include consideration of both acute and recovery phases of the disease during prognostication, discussion of the possible need for mechanical ventilation and enteral nutrition during counseling, and consideration of the complete clinical condition as opposed to a single variable during prognostication. Conclusions These guidelines provide recommendations on the reliability of predictors of the need for mechanical ventilation, poor functional outcome, and independent ambulation following GBS in the context of counseling patients and/or surrogates and suggest broad principles of neuroprognostication. Few predictors were considered moderately reliable based on the available body of evidence, and higher quality data are needed.

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Section: Methodsmentioning

confidence: 99%