Rate of progression of Guillain-Barré syndrome is not associated with the short-term outcome of the disease

Disability evaluation in patients with Guillain-Barre syndrome and SARS-CoV-2 infection

Objective

Several cases of Guillain-Barre syndrome (GBS) associated with SARS-CoV-2 infection have been described. This study illustrated the demographic, clinical, and neurophysiological characteristics of patients with GBS and COVID-19, as well as associated factors with disability at discharge.

Materials and methods

A retrospective analytical observational study was conducted. It included patients diagnosed with GBS admitted in a national reference center in Peru between 2019 and 2021. Epidemiological, clinical, neurophysiological, and cerebrospinal fluid data were analyzed. A multivariate analysis, using the generalized linear model, was performed, considering the presence of disability at discharge as the dependent variable.

Results

Eight-one subjects diagnosed with GBS were included. The mean age was 46.8 years (SD: 15.2), with a predominance of males (61.73%). The most frequent clinical presentation was the classic sensory-motor form in 74 cases (91.36%) with AIDP (82.35%) as the most frequent neurophysiological pattern in the group with COVID-19, while AMAN pattern predominated (59.26%) in those without COVID-19 (p = <0.000). The disability prevalence ratio at discharge between subjects with COVID-19 and those without COVID-19 was 1.89 (CI 1.06-3.34), p = 0.030, adjusted for age, sex, and neurophysiological subtype.

Conclusion

The neurophysiologic subtype AIDP, and a higher disability were associated with the presence of COVID-19.

Hyperacute and Fulminant Guillain-Barré Syndrome Requiring Emergent Intubation

Guillain-Barré syndrome (GBS) is an autoimmune-mediated acute polyneuropathy that can progress to life-threatening respiratory failure. The diagnosis and treatment of this pathology are complicated by the rarity of the disease and diversity in clinical presentation due to rarer, more dangerous subtypes of GBS. Understanding the time course of progression from onset to nadir of neurological deficits, maintaining a high index of suspicion, and close airway monitoring are essential in rapid diagnosis, securing the airway, and treatment.

Atypical Guillain-Barre Syndrome With a Sensory Level and Hyper-Acute Presentation: A Case Report

A 46-year-old man with a prior history of cervical spondylosis and myelopathy needing cervical spinal surgery three years back presented to the emergency department with acute onset areflexic flaccid weakness of both lower extremities, with a sensory level at T10. Magnetic resonance imaging studies (MRI) of the cervical, thoracic, and lumbar spine ruled out significant cord compression, spinal cord ischemia, spinal shock, or findings to suggest transverse myelitis. CSF analysis showed normal albumin and protein; however, with the features of paraplegia with flaccidity, areflexia, absence of bowel and bladder symptoms, and MRI ruling out other possibilities, a diagnosis of Guillain-Barre syndrome (GBS) was made. The patient was treated with intravenous immunoglobulin (IVIG) and showed a clinical response, with improvement in strength in both lower extremities. This case is rare and unique, as it exhibits atypical features for a GBS case, including a sensory level and hyper-acute presentation, with the onset of weakness to a nadir within an hour. This case highlights the importance of awareness of such atypical GBS presentations so that the diagnosis is not missed and is appropriately managed for favorable patient outcomes.

Neutrophil-to-lymphocyte ratio is a risk indicator of Guillain-Barré syndrome and is associated with severity and short-term prognosis

Introduction

Guillain-Barré syndrome (GBS) is an autoimmune disorder targeting the peripheral nervous system. The neutrophil-to-lymphocyte ratio (NLR), a simple indicator of immune function, is potentially related to its incidence and severity; however, this should be confirmed. We aimed to evaluate the role of NLR in the diagnosis, severity, and prognosis of GBS.

Methods

Data of GBS patients and controls visiting our hospital from January 2010 to December 2020 were retrospectively analyzed (Clinical trial registration: ChiCTR2100053540). Risk factors were determined through logistic regression. Smoothing curves, receiver-operating characteristic curves, and forest plots were drawn.

Results

We included 136 GBS patients and 211 controls. NLR, as a continuous variable, was associated with GBS risk (OR, 2.32; 95% CI, 1.68-3.21; p < 0.001), severe functional disability (OR, 1.23; 95% CI, 1.06-1.43; p = 0.006), severe weakness (OR, 1.19; 95% CI, 1.06-1.35, p = 0.004), and short-term prognosis (OR, 1.21; 95% CI, 1.08-1.36; p = 0.001). NLR was more strongly associated with GBS risk in older (≥60 years) (OR, 7.17; 95% CI, 2.38-21.61) or male (OR, 2.88; 95% CI, 1.78-4.64) patients than in younger (<60 years) (OR, 1.88; 95% CI, 1.37-2.57) or female (OR, 1.85; 95% CI, 1.24-2.77) patients. NLR was significantly associated with severe functional disability in faster disease progression (OR, 1.53; 95% CI, 1.03-12.29) and male patients (OR, 1.41; 95% CI, 1.03-1.92) versus in slower disease progression (OR, 1.12; 95% CI, 0.77-1.64) and female patients (OR, 1.12; 95% CI, 0.77-1.64).

Conclusions

NLR may be an independent GBS risk factor and predictor of severe functional disability, severe weakness, and short-term prognosis.