Modified Erasmus GBS Respiratory Insufficiency Score: a simplified clinical tool to predict the risk of mechanical ventilation in Guillain-Barré syndrome

Abstract

BackgroundThis study aimed to determine the clinical and diagnostic factors associated with mechanical ventilation (MV) in Guillain-Barré syndrome (GBS) and to simplify the existing Erasmus GBS Respiratory Insufficiency Score (EGRIS) for predicting the risk of MV.MethodsData from the first 1500 patients included in the prospective International GBS Outcome Study (IGOS) were used. Patients were included across five continents. Patients <6 years and patients from Bangladesh were excluded. Univariable logistic and multivariable Cox regression were used to determine which prespecified clinical and diagnostic characteristics were associated with MV and to predict the risk of MV at multiple time points during disease course.Results1133 (76%) patients met the study criteria. Independent predictors of MV were a shorter time from onset of weakness until admission, the presence of bulbar palsy and weakness of neck flexion and hip flexion. The modified EGRIS (mEGRIS) was based on these factors and accurately predicts the risk of MV with an area under the curve (AUC) of 0.84 (0.80–0.88). We internally validated the model within the full IGOS cohort and within separate regional subgroups, which showed AUC values of 0.83 (0.81–0.88) and 0.85 (0.72–0.98), respectively.ConclusionsThe mEGRIS is a simple and accurate tool for predicting the risk of MV in GBS. Compared with the original model, the mEGRIS requires less information for predictions with equal accuracy, can be used to predict MV at multiple time points and is also applicable in less severely affected patients and GBS variants. Model performance was consistent across different regions.

European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain–Barré syndrome

“…mEGRIS prognostic model : An individual patient's risk of requiring mechanical ventilation can be estimated by using EGRIS 160,161 the updated version of EGRIS, 162 and now with the modified (and simplified) version mEGRIS 159 . An advantage of mEGRIS is that it can be used across the full spectrum of GBS, including mild cases and variants, and in patients from different regions.…”

“… The TF advises assessing the risk of respiratory failure early in the course of GBS. The TF advises using a prognostic model at hospital admission to quantify the risk of requiring mechanical ventilation. This can be quantified using the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) 159 . mEGRIS requires four clinical factors to estimate the risk of requiring mechanical ventilation at any time during the first 2 months from disease onset.…”

“…This can be quantified using the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS). 159 F I G U R E 2 Assessment and monitoring of patients with GBS. This GPP based flowchart on the assessment and monitoring of GBS patients is based upon clinical studies and prognostic scales (PICO 7 and 14).…”

The early clinical and laboratory predictors of GBS outcome: hospital-based study, Assiut University, Upper Egypt

“…A higher GDS score on admission was a strong predictor for poor outcome at discharge and short-term follow-up, independent of treatment type or in-hospital management (Ruiz-Sandoval and their colleagues) [12]. Luijten and their colleagues found that clinical predictors of the need for mechanical ventilation (MV) were a shorter time from onset of weakness until admission, the presence of facial muscle weakness, bulbar palsy and neck muscle weakness [13].…”

“…Number of days between onset of symptoms and nadirMean ± SD (range 1-7 days)3.32 ± 1.64Number of days between onset of weakness and admissionMean ± SD (range) 6.69 ± 4.51(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) Type of antecedent event number = 43 (69.4%)…”