Predictors of mechanical ventilation in Guillain-Barré syndrome with axonal subtypes Academic Article in Scopus uri icon

abstract

  • © 2022 Cambridge University Press. All rights reserved.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 (IQR: 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 AMAN being the most prevalent (34.9%), followed by AIDP (32.6%), 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 PLEX (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.

publication date

  • March 22, 2023