Risk factors for respiratory failure in Guillain‐Barré syndrome in Bangladesh: a prospective study

Abstract

Objective We investigated clinical, biological, and electrophysiological risk factors for mechanical ventilation (MV) and patient outcomes in Bangladesh using one of the largest, prospective Guillain‐Barré syndrome (GBS) cohorts in developing world. Methods A total of 693 GBS patients were included in two GBS studies conducted between 2006 and 2016 in Dhaka, Bangladesh. Associations between baseline characteristics and MV were tested using Fisher's exact test, χ 2 test, or Mann–Whitney U ‐test, as appropriate. Risk factors for MV were assessed using multivariate logistic regression. Survival analysis was performed using Kaplan–Meier method; comparisons between groups performed using log‐rank test. Results Of 693 patients, 155 (23%) required MV (median age, 26 years; interquartile range [IQR] 17–40). Among the ventilated patients, males were predominant (68%) than females. The most significant risk factor for MV was bulbar involvement (adjusted odds ratio [AOR]:19.07; 95% CI = 89.00–192.57, P = 0.012). Other independently associated factors included dysautonomia (AOR:4.88; 95% CI = 1.49–15.98, P = 0.009) and severe muscle weakness at study entry (AOR:6.12; 95% CI = 0.64–58.57, P = 0.048). At 6 months after disease onset, 20% of ventilated and 52% of non‐ventilated patients ( P < 0.001) had recovered completely or with minor symptoms. Mortality rate was significantly higher among ventilated patients than non‐ventilated patients (41% vs. 7%, P < 0.001). Interpretation Bulbar involvement, dysautonomia and severe muscle weakness were identified as the most important risk factors for MV among GBS patients from Bangladesh. The findings may help to develop predictive models for MV in GBS in developing countries to identify impending respiratory failure and proper clinical management of GBS patients.

Predictors and Risk Factors of Severity of GBS, the Requirement for Mechanical Ventilation and Poor Short-Term Prognosis of Severe GBS

“…The scoring system "The Erasmus GBS Respriatory Insu ciency Score(EGOS)" was developed by Walgaard et.al on the basis of three respiratory insu ciency predictors: facial and/or bulbar weakness at admission, MRC sum score at admission and the time onset to admission [18].This nding was further proved by the multivariate regression analysis, which identi ed lower MRC at admission and autonomic dysfunction were independent predictors for MV in severe GBS. Islam et.al found that severe muscle weakness(MRC sum scores ranging 0 from 20) at study entry was more likely to progress to MV [21]. Autonomic dysfunction was thirteen time more common in MV patients than NV patients in the present study.It was in accordance with result of a cohort study that reported dysautonomia as an independent predictor of respiratory insu ciency [22,23].…”

Guillain–Barré syndrome in low-income and middle-income countries: challenges and prospects

“…Therefore, only 10‒12% of patients in Bangladesh receive one of these treatments, even though most patients with GBS in Bangladesh are severely affected. For instance, 93% of patients from Bangladesh were unable to walk independently at nadir (GBS disability score >2) in comparison with 76% of patients in Europe, America or other parts of Asia 12 , 18 , 22 , 109 . This situation underscores the need for low-cost and effective treatment strategies for GBS in LMIC.…”

“…Admission to the ICU is recommended for patients with GBS who have imminent respiratory insufficiency, severe autonomic dysfunction with cardiovascular instability, severe swallowing dysfunction and/or diminished cough reflex or rapidly progressive weakness 109 , 113 – 116 . However, in LMIC the number of ICU beds is limited and ICU services in private hospitals are too costly (~US$300–1,200 daily) for most patients 71 , 117 .…”

Facing acute neuromuscular diseases during COVID-19 pandemic: focus on Guillain–Barré syndrome

“…In addition to weakness, patients might initially have sensory signs, ataxia, and features of autonomic dysfunction [ 36 – 38 , 41 – 43 ]. Respiratory insufficiency is a life-threatening manifestation that occurs in 20–30% of patients [ 48 , 49 ]. Many different antecedent infections have been identified as triggers of GBS, but only for a few microorganisms an association has been shown in case–control studies [ 46 – 48 ].…”

“…Respiratory insufficiency is a life-threatening manifestation that occurs in 20–30% of patients [ 48 , 49 ]. Many different antecedent infections have been identified as triggers of GBS, but only for a few microorganisms an association has been shown in case–control studies [ 46 – 48 ]. Campylobacter jejuni ( C. jejuni ) is the predominant antecedent infection, found in 25–50% of adult patients [ 38 , 41 ].…”