Predictors of Mechanical Ventilation in Guillain–Barré Syndrome with Axonal Subtypes

Abstract

Background: The early clinical predictors of respiratory failure in Latin Americans with Guillain–Barré syndrome (GBS) have scarcely been studied. This is of particular importance since Latin America has a high frequency of axonal GBS variants that may imply a worse prognosis. Methods: We studied 86 Mexican patients with GBS admitted to the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, a referral center of Mexico City, to describe predictors of invasive mechanical ventilation (IMV). Results: The median age was 40 years (interquartile range: 26–53.5), with 60.5% men (male-to-female ratio: 1.53). Most patients (65%) had an infectious antecedent (40.6% gastrointestinal). At admission, 38% of patients had a Medical Research Council (MRC) sum score <30. Axonal subtypes predominated (60.5%), with acute motor axonal neuropathy being the most prevalent (34.9%), followed by acute inflammatory demyelinating polyneuropathy (32.6%), acute motor sensory axonal neuropathy (AMSAN) (25.6%), and Fisher syndrome (7%). Notably, 15.1% had onset in upper limbs, 75.6% dysautonomia, and 73.3% pain. In all, 86% received either IVIg (9.3%) or plasma exchange (74.4%). IMV was required in 39.5% patients (72.7% in AMSAN). A multivariate model without including published prognostic scores yielded the time since onset to admission <15 days, axonal variants, MRC sum score <30, and bulbar weakness as independent predictors of IMV. The model including grading scales yielded lower limbs onset, Erasmus GBS respiratory insufficiency score (EGRIS) >4, and dysautonomia as predictors. Conclusion: These results suggest that EGRIS is a good prognosticator of IMV in GBS patients with a predominance of axonal electrophysiological subtypes, but other early clinical data should also be considered.

Incidence of Guillain–Barré syndrome following SARS‐CoV‐2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines

“…This may be the result of genetic and environmental differences, as demyelinating variants are more frequent in white populations, while axonal variants are more frequent in Latin American and Asian populations [ 41 ]. The proportion of axonal variants and mortality rate we observed are consistent with pre‐COVID‐19 rates, where axonal subtypes accounted for up to 60% of cases, with an overall mortality rate as high as 12% [ 42 , 43 , 44 ].…”

Factors Predicting Prolonged Mechanical Ventilation in Guillain–Barré Syndrome

“…AMAN has a worse functional outcome compared to AIDP, and a previous study in our country reported a higher frequency of mechanical ventilation in axonal variants. 1,26 In our study, we did not observe differences between the electrophysiological variants requiring prolonged mechanical ventilation. Severe axonal damage (distal CMAP ≤1.0 mV) is associated with a worse outcome.…”

Incidence of Guillain-Barré syndrome following SARS-CoV-2 immunization in Mexico: A nation-wide registry of seven COVID-19 vaccines

“…42 The proportion of axonal variants and mortality rate we observed is consistent with pre-COVID-19 rates, where axonal subtypes accounted for up to 60% of cases with an overall mortality rate as high as 12%. [43][44][45] Interestingly, when comparing mRNA-based versus adeno-vectored vaccines, we observed a higher incidence ratio for mRNA platforms. These variations in such large samples suggest that genetic and environmental factors may result in increased susceptibility to GBS among recipients of specific SARS-CoV-2 vaccines.…”