The usefulness of chief complaints to predict severity, ventilator dependence, treatment option, and short-term outcome of patients with Guillain-Barré syndrome: a retrospective study

Abstract

BackgroundIt remains an urgent need for early recognition of disease severity, treatment option and outcome of Guillain-Barré syndrome (GBS). The chief complaint may be quickly obtained in clinic and is one of the candidates for early predictors. However, studies on the chief complaint are still lacking in GBS. The aim of the study is to describe the components of chief complaints of GBS patients, and to explore association between chief complaints and disease severity/treatment option/outcome of GBS, so as to aid the early prediction of the disease course and to assist the clinicians to prescribe an optimal early treatment.MethodsA total of 523 GBS patients admitted to the First Hospital of Jilin University from 2003 to 2013 were enrolled for retrospective analysis. The data of chief complaints, clinical manifestations, and treatment options, etc. were collected. The clinical severity was evaluated by the Medical Research Council sum score and the Hughes Functional Grading Scale. The prognosis at 6 month after discharge was described by modified Erasmus GBS outcome score. The clinic GBS severity evaluation scale (CGSES), a newly established model in our study, was used to explore the role of chief complaints to predict intravenous immunoglobulin (IVIg).ResultsThe major components of the chief complaints of GBS patients were weakness, numbness, pain, cranial nerve involvement, dyspnea, ataxia and autonomic dysfunction. Chief complaint of weakness was a predictor of severe disease course and poor short-term outcome, while chief complaint of numbness and cranial nerve involvement were promising predictors. Cranial nerve involvement was the predictor of ventilator dependence. The percentages of 366 GBS patients, who need IVIg treatment at nadir with CGSES ranging from 1 to 4, were 50.00, 67.34, 80.61, and 90.67%, respectively.ConclusionsChief complaints are clinic predictors of disease severity, ventilator dependence and short-term outcome. IVIg treatment during hospitalisation could be predicted in clinic using CGSES score.

Risk factors for the severity of Guillain-Barré syndrome and predictors of short-term prognosis of severe Guillain-Barré syndrome

“…One was autonomic dysfunction; we found that severe GBS patients with dysautonomia were more likely to need MV than those without autonomic dysfunction. This was in accordance with the results of a cohort study that reported dysautonomia as an independent predictor of respiratory insufficiency 19 , 20 and the results of Bangladesh et al that identified bulbar involvement, autonomic dysfunction, and severe muscle weakness as important risk factors for MV among Bangladeshi GBS patients 21 . Therefore, strengthening airway management is very important for GBS patients with autonomic dysfunction.…”

Predictors and Risk Factors of Severity of GBS, the Requirement for Mechanical Ventilation and Poor Short-Term Prognosis of 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]. In contract, age, facial paresis, antecedent infection, sensory, pain, place of residence and treatment option showed no association with the need for mechanical ventilation.…”

Guillain–Barre Syndrome

“…Pain is a relatively uncommon but still recognizable manifestation in approximately 15% of patients. 40 Around half of patients diagnosed with GBS develop autonomic dysfunction, with the most common being gastrointestinal manifestations (diarrhea/constipation) in 15% of patients, followed by hyponatremia (15%), syndrome of inappropriate antidiuretic hormone secretion (5%), bradycardia (5%), and urinary retention (4%). Other manifestations of autonomic dysfunction such as tachycardia, blood pressure instability, reversible cardiomyopathy, syncope, and Horner syndrome are rare.…”

“…Other manifestations of autonomic dysfunction such as tachycardia, blood pressure instability, reversible cardiomyopathy, syncope, and Horner syndrome are rare. 40,41 Cranial neuropathies can occur in up to 60% of patients and may involve multiple cranial nerves. Bulbar weakness, facial palsy, ophthalmoplegia, and hypoglossal nerve palsy are the most prevalent manifestations of cranial neuropathy.…”

“…Bulbar weakness, facial palsy, ophthalmoplegia, and hypoglossal nerve palsy are the most prevalent manifestations of cranial neuropathy. 40,42 ►Table 2 illustrates the common manifestations that favor the diagnosis of GBS.…”