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Sun RD, Jiang J, Deng XL. Factors Associated with Respiratory Insufficiency in Children with Guillain-Barré Syndrome. Neuropediatrics 2024; 55:112-116. [PMID: 38253279 PMCID: PMC10940050 DOI: 10.1055/s-0043-1777767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/09/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE The risk factors for respiratory insufficiency in children with Guillain-Barré syndrome (GBS) are poorly known. This study aimed to investigate the factors associated with respiratory insufficiency in children with GBS. METHODS This retrospective study included children diagnosed with GBS by pediatric neurologists and admitted at the Wuhan Children's Hospital and other hospitals from January 2013 to October 2022. The patients were divided into the respiratory insufficiency and nonrespiratory insufficiency groups according to whether they received assist breathing during treatment. RESULTS The median (interquartile range) age of onset of 103 patients were 5 (3.1-8.5) years, 69 (67%) were male, and 64 (62.1%) had a history of precursor infection. Compared with the nonrespiratory insufficiency group, the respiratory insufficiency group showed more facial and/or bulbar weakness (p = 0.002), a higher Hughes Functional Grading Scale (HFGS) at admission (p < 0.001), and a shorter onset-to-admission interval (p = 0.017). Compared with the acute motor axonal neuropathy (AMAN) subtype, the acute inflammatory demyelinating polyneuropathy (AIDP) subtype showed longer days from onset to lumbar (p = 0.000), lower HFGS at admission (p = 0.04), longer onset-to-admission interval (p = 0.001), and more cranial nerve involvement (p = 0.04). The incidence of respiratory insufficiency between AIDP and AMAN showed no statistical difference (p > 0.05). CONCLUSION In conclusion, facial and/or bulbar weakness, HFGS at admission, and onset-to-admission interval were associated with respiratory insufficiency and might be useful prognostic markers in children with GBS.
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Affiliation(s)
- Rui-di Sun
- Department of Electrophysiology, Wuhan Children's Hospital (Wuhan Maternal and Children's Healthcare Center), Wuhan, People's Republic of China
| | - Jun Jiang
- Department of Electrophysiology, Wuhan Children's Hospital (Wuhan Maternal and Children's Healthcare Center), Wuhan, People's Republic of China
| | - Xiao-long Deng
- Department of Pediatric Neurology, Wuhan Children's Hospital (Wuhan Maternal and Children's Healthcare Center), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Jahan I, Ahmed R, Ahmed J, Khurshid S, Biswas PP, Upama IJ, Hamid Y, Papri N, Islam Z. Neutrophil-lymphocyte ratio in Guillain-Barré syndrome: A prognostic biomarker of severe disease and mechanical ventilation in Bangladesh. J Peripher Nerv Syst 2023; 28:47-57. [PMID: 36700342 PMCID: PMC10155239 DOI: 10.1111/jns.12531] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023]
Abstract
In addition to cellular and humoral immunity, inflammatory markers play an important role in the pathogenesis of Guillain-Barré syndrome (GBS) and are used to predict prognosis in many autoimmune diseases. The aim of this study was to identify whether the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, and monocyte-lymphocyte ratio in the early stages of GBS have prognostic value for severe disease, mechanical ventilation (MV) and poor long-term outcome. A prospective cohort study of 140 adult patients with GBS and 140 healthy controls (HC) was performed in Bangladesh during 2019-2022. Clinicodemographic characteristics of the patients were recorded, and hematological parameters were measured using an automated hematology analyzer. Median patient age was 35 (44-23) years; 71% were male; 88% were severely affected (GBS Disability Score> 3); 32% required MV. Patients had higher NLR than HC (P< .0001). Among patients, elevated NLR was associated with severe GBS and MV (P= .001 and <.0001, respectively) and moderately positively correlated with poor outcomes at 4 weeks (r = 0.423). Multiple logistic regression revealed NLR was an independent risk factor for severe GBS (OR = 5.2, 95% CI = 1.6-17.4) and MV (OR = 1.5 1.1-2.1). No significant association was observed between elevated NLR and the long-term outcome of GBS. Receiver operating characteristic curves revealed NLR cut-off values of ≥ 2.432 and ≥ 4.4423 predicted severe disease (sensitivity = 71%, specificity = 75%, AUC = 0.750, 95% CI = 0.651-0.849, P = .001) and MV (sensitivity = 65.9%, specificity = 81.7%, AUC = 0.804, 95% CI=0.724-0.884; P< .001). The NLR in the early stage of GBS may represent an independent prognostic factor of severe GBS and the requirement for MV.
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Affiliation(s)
- Israt Jahan
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rasel Ahmed
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Jigishu Ahmed
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Sarah Khurshid
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Pritha Promita Biswas
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Ismat Jahan Upama
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Yameen Hamid
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - Nowshin Papri
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Zhahirul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
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Sutantoyo FF, Fadil, Basuki M, Fidiana, Hamdan M. Correlation Between Neutrophil-to-Lymphocyte Ratio and Motoric Deterioration in Patients With Guillain-Barre Syndrome. J Clin Neurol 2022; 18:671-680. [DOI: 10.3988/jcn.2022.18.6.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Felisitas Farica Sutantoyo
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Fadil
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Mudjiani Basuki
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Fidiana
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Muhammad Hamdan
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
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Wen P, Wang L, Liu H, Gong L, Ji H, Wu H, Chu W. Risk factors for the severity of Guillain-Barré syndrome and predictors of short-term prognosis of severe Guillain-Barré syndrome. Sci Rep 2021; 11:11578. [PMID: 34079013 PMCID: PMC8172857 DOI: 10.1038/s41598-021-91132-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/17/2021] [Indexed: 01/28/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is a neurological disorder characterized by paralysis. Identifying the severity, appropriate therapeutic method, and prognosis of GBS at an early stage is highly important. This study aimed to investigate the modifiable risk factors for the severity of GBS and consequent need for mechanical ventilation (MV) and to identify clinical predictive factors for poor short-term outcomes of severe GBS. 155 GBS patients who were admitted to the Affiliated Yantai Yuhuangding Hospital of Qingdao University during 2014–2020 were enrolled. Demographic, clinical, therapeutic and evolutionary data were collected and were then analyzed using univariate and multivariate regression analyses. Our analytic data demonstrated that the significant clinical predictors of severe GBS were recent history of surgery, older age, cranial nerve impairment, and elevated levels of liver enzymes (p < 0.05). Furthermore, autonomic dysfunction, lower Medical Research Council (MRC) score at nadir, and elevated levels of liver enzymes were significantly associated with MV for severe GBS (p < 0.05), and lower MRC score at nadir and autonomic dysfunction remained significant predictors of MV in severe GBS (p < 0.05). Lastly, recent history of surgery, lower MRC score at admission and at nadir, requirement for MV, and pneumonia during hospitalization were significantly associated with the short-term outcome of severe GBS and that lower MRC score at admission and need for MV were confirmed to be predictors of poor short-term prognosis (p < 0.05). Of note, this study suggested that recent history of surgery is a predictor of severity in GBS patients and is associated with the poor short-term prognosis of severe GBS.
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Affiliation(s)
- Puyuan Wen
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Lisha Wang
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Hong Liu
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Li Gong
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Han Ji
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Hongliang Wu
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China.
| | - Wenzheng Chu
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China.
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Shalman A, Savir S, Mechnik Steen Y, Ovanyan A, Boniel N, Koyfman L, Bichovsky Y, Zlotnik A, Klein M, Brotfain E. Albumin levels as a biomarker for second Intravenous Immunoglobulin (IVIG) treatment in Guillain-Barre syndrome (GBS). J Clin Neurosci 2020; 74:247-249. [PMID: 32088107 DOI: 10.1016/j.jocn.2020.01.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with GBS may develop hypoalbuminemia following treatment with Intravenous Immunoglobulin (IVIG), which is related to a poorer outcome. This report presents a patient with GBS and his clinical response to two courses of IVIG treatments in association with his albumin level. CASE REPORT A previously healthy 21-year-old male was admitted to the GICU due to GBS with severity grade 5 (required assisted ventilation). IVIG treatment was initiated. Over the next two weeks there was no clinical improvement and Albumin level dropped from 4.5 gr/dL to a nadir of 2.3 gr/dL. A second course of IVIG was initiated. After initiation of the second course the patient's albumin began rising to 3.0 gr/dL and a clinical improvement followed this rise. Subsequently, he was weaned from mechanical ventilation within a few days. CONCLUSIONS When considering a second course of IVIG treatment, serum albumin levels may be considered a biomarker as part of the decision algorithm.
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Affiliation(s)
- Anna Shalman
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shiri Savir
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Yana Mechnik Steen
- Department of Neurology Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Andrey Ovanyan
- Department of Neurology Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Nancy Boniel
- Department of Radiology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Koyfman
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoav Bichovsky
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Klein
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Evgeni Brotfain
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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