Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain–Barré Syndrome

Abstract

Background and objectives: Myasthenia gravis (MG) and Guillain–Barré Syndrome (GBS) are autoimmune neuromuscular disorders that may present as neuromuscular emergencies requiring mechanical ventilation and critical care. Comparative outcomes of these disease processes, once severe enough to require mechanical ventilation, are not known. In this study, we compared the patients requiring mechanical ventilation in terms of in-hospital complications, length of stay, disability, and mortality between these two disease entities at a national level. Materials and Methods: Mechanically ventilated patients with primary diagnosis of MG (n = 6684) and GBS (n = 5834) were identified through retrospective analysis of Nationwide Inpatient Sample (NIS) database for the years 2006 to 2014. Results: Even though mechanically ventilated MG patients were older (61.0 ± 19.1 versus 54.9 ± 20.1 years) and presented with more medical comorbidities, they had lower disease severity on admission, as well as lower in-hospital complications sepsis, pneumonia, and urinary tract infections as compared with GBS patients. In the multivariate analysis, after adjusting for confounders including treatment, GBS patients had significantly higher disability (odds ratio (OR) 15.6, 95% confidence interval (CI) 10.9–22.2) and a longer length of stay (OR 3.48, 95% CI 2.22–5.48). There was no significant difference in mortality between the groups (8.45% MG vs. 10.0% GBS, p = 0.16). Conclusion: Mechanically ventilated GBS patients have higher disease severity at admission along with more in-hospital complications, length of stay, and disability compared with MG patients. Potential explanations for these findings include delay in the diagnosis, poor response to immunotherapy particularly in patients with axonal GBS variant, or longer recovery time after nerve damage.

Comparison of Clinical and Biochemical Parameters of Patients with Guillain Barre Syndrome and Myasthenia Gravis: Retrospective Single Center Experience

“…Respiratory and blood gas parameters should be closely monitored in these patients. 2 In respiratory involvements, blood lactate level due to hypoxia increases. 17 In our study, the lactate levels of GBS and MG patients were compared for the first time in the literature, and it was found that MG patients had statistically higher blood lactate levels.…”

“…The involvement of the external eye muscles and other facial, chewing, and swallowing muscles are prioritized. 1,2 Application complaints of MG patients, mostly similar…”

“…Both are the diseases of the peripheral nervous system that goes by the pathology of neurons or neuromuscular junction. 1,2 GBS is an acute-onset and inflammatory polyneuropathic disease of the peripheral nervous system. GBS symptoms usually appear in 10 to 14 days following upper or lower respiratory disease or acute gastroenteritis.…”

“…It is mostly associated with thymic tumor, thyrotoxicosis, rheumatoid arthritis, or disseminated lupus erythematosus. 2 Bilateral, rapid, progressive, and ascending muscle weakness is typically seen in GBS. In the extremities with muscle weakness, areflexia or decreased tendon reflexes are observed.…”

“…6,9 In the treatment, intravenous immunoglobulin (IVIG) and plasmapheresis should be started as soon as possible supportive therapy should be applied concomitantly. 2,6,10 The most common cause of mortality in both diseases is respiratory failure. 1 In this study, we aimed to compare the arrival complaints, clinical course, and laboratory parameters of GBS and MG patients.…”