Prognostic Factors in Elderly Patients With Guillain-Barré Syndrome: Does Age Matter?

Abstract

Introduction: Twenty to 40% of Guillain Barré syndrome (GBS) patients will not be able to walk independently despite effective treatment. Older patients carry additional risks for worse outcomes. Methods: A single center, ambispective cohort study was performed. Only subjects ≥18 years with a 3-month follow-up were included. Elderly patients were considered as a whole if ≥ 60 years. Demographics, CSF and nerve conduction studies were compared. A binomial logistic regression and Kaplan-Meier analyses were carried out to estimate good prognosis (Hugues ≤2) at 3-month follow-up. Results: From 130 patients recruited, 27.6% were elderly adults. They had a more severe disease, higher mEGOS and more cranial nerve involvement. Age ≥70 years, invasive mechanical ventilation and axonal subtype, portrayed an unfavorable 3-month outcome. Further analysis demonstrated an earlier recovery in independent walk at 3 months for patients <70 years. Conclusions: Elderly patients with GBS have a more severe disease at admission and encounter worse prognosis at 3-month follow-up, especially those above 70 years.

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

“…Regarding disease severity, 91.8% of our patients had severe GBS compared to 58.5% reported in ChAdOx1 nCoV‐19 and mRNA‐1273 recipients in the United Kingdom [ 10 ]. This may be attributable to differences in electrophysiological variants, as patients with axonal variants, known to develop a more severe disease course with worse functional outcomes [ 40 , 41 ], accounted for 60.5% of our cases, whereas demyelinating variants accounted for 79.5% of theirs. 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 ].…”

Guillain-Barr� syndrome in Mexico: An updated review amid the coronavirus disease 2019 era

“…Risk factors for a poor functional outcome (inability to walk unaided) include older age, severe presentation, and mechanical ventilation requirement 18 . A recent Mexican study reported that patients aged >70 years had a delayed gait recovery compared to younger patients 4 . Mechanical ventilation directly impacts the functional outcome and prognosis.…”

“…Small volume PLEX (total exchange of 140 mL/kg over 8 days) is a safe and feasible treatment in low-income countries where IVIg and PLEX are unavailable or unaffordable 10 . In Mexico, the decision between IVIg and PLEX depends on treatment availability, and recent studies report that only 63-75% of patients are so treated 3,4,9 .…”

“…GBS represents a neurological emergency as, despite proper treatment, up to 20% of patients will become seriously disabled, and approximately 5% will die 1 . Regardless of recent advances in GBS knowledge, mortality in Mexico has been reported to be as high as 12% 3,4 .…”

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

“…11,12,37,38 Regarding disease severity, 91•8% of our patients had a severe form (GBS disability score ≥ 3) compared to the 58•5% of severe cases reported by Keh and colleagues among ChAdOx1 nCoV-19 and mRNA-1273 recipients in the United Kingdom. 11 This may be due to differences in electrophysiological variants, as patients with axonal variants, known to develop a more severe disease course with worse functional outcomes, 41,42 accounted for 60•5% of our cases, whereas demyelinating variants accounted for 79•5% of theirs. This can be explained in part by genetic and environmental differences, as demyelinating variants are more frequent in Caucasians, while axonal variants are more frequent in Latin American and Asian populations.…”