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Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome.

Wu X, Li C, Zhang B, Shen D, Li T, Liu K, Zhang HL - Crit Care (2015)

Bottom Line: Combined use of intravenous corticosteroids with intravenous immunoglobulin (odds ratio 10.200, 95% confidence interval 1.068-97.407, p < 0.05) was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection.Clinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct.Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.

View Article: PubMed Central - PubMed

Affiliation: Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China. wuxiujuan861003@126.com.

ABSTRACT

Introduction: Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system. Respiratory failure requiring mechanical ventilation (MV) is a serious complication of GBS. Identification of modifiable risk factors for MV and poor short-term prognosis in mechanically ventilated patients with GBS may contribute to the individualized management and may help improve the outcome of the patients.

Methods: We retrospectively analyzed the clinical data of 541 patients who were diagnosed with GBS from 2003 to 2014. Independent predictors for MV and short-term prognosis in mechanically ventilated patients were identified via multivariate logistic regression analysis.

Results: The mean age was 41.6 years with a male predilection (61.2%). Eighty patients (14.8%) required MV. Multivariate analysis revealed that shorter interval from onset to admission (p < 0.05), facial nerve palsy (p < 0.01), glossopharyngeal and vagal nerve deficits (p < 0.01) and lower Medical Research Council (MRC) sum score at nadir (p < 0.01) were risk factors for MV; disease occurrence in summer (p < 0.01) was a protective factor. As to prognostic factors, absence of antecedent infections (p < 0.01) and lower MRC sum score at nadir (p < 0.01) were predictors of poor short-term prognosis in mechanically ventilated patients regardless of treatment modality. We further investigated the predictors of poor short-term prognosis in patients requiring MV with different nadir MRC sum scores. Combined use of intravenous corticosteroids with intravenous immunoglobulin (odds ratio 10.200, 95% confidence interval 1.068-97.407, p < 0.05) was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection.

Conclusions: Clinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct. Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.

No MeSH data available.


Related in: MedlinePlus

Comparisons between patients with and without mechanical ventilation. a The seasonal distribution in GBS occurrence was different between Group MV and Group NV. More GBS patients with mechanical ventilation were found in winter, while those without mechanical ventilation were more common in summer (both p < 0.05). b Time from onset to admission and time from onset to nadir were both shorter in Group MV (3.5 versus 6.3 and 5.9 versus 7.6; both p < 0.05). As assessed by c the MRC sum score and d HFGS, more severe disease severity was found in Group MV (MRC, 16.6 versus 41.0; HFGS, 5 versus 3.0; both p < 0.05). Group MV GBS patients with mechanical ventilation, Group NV GBS patients did not require mechanical ventilation, HFGS Hughes Functional Grading Scale, MRC Medical Research Council (sum score)
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Fig1: Comparisons between patients with and without mechanical ventilation. a The seasonal distribution in GBS occurrence was different between Group MV and Group NV. More GBS patients with mechanical ventilation were found in winter, while those without mechanical ventilation were more common in summer (both p < 0.05). b Time from onset to admission and time from onset to nadir were both shorter in Group MV (3.5 versus 6.3 and 5.9 versus 7.6; both p < 0.05). As assessed by c the MRC sum score and d HFGS, more severe disease severity was found in Group MV (MRC, 16.6 versus 41.0; HFGS, 5 versus 3.0; both p < 0.05). Group MV GBS patients with mechanical ventilation, Group NV GBS patients did not require mechanical ventilation, HFGS Hughes Functional Grading Scale, MRC Medical Research Council (sum score)

Mentions: A total of 541 adult patients were enrolled. The mean age was 41.6 years with a male preponderance (61.2 %). Eighty (14.8 %) patients requiring MV during hospitalization were placed into Group MV, while the remaining 461 patients were in the Group NV. Comparisons between Group MV and Group NV are demonstrated in Table 1. We found that cranial nerve involvement was more common in Group MV (66.3 % versus 39.9 %, p < 0.05), as was a longer hospitalization period (38.7 versus 14.6, p < 0.05). Seasonal distribution was also significantly different between the two groups, as shown in Fig. 1a. More patients with MV (Group MV) were admitted in winter while more patients without MV (Group NV) were admitted in summer (both p < 0.05). Time from onset to admission and time from onset to nadir was both shorter in the Group MV (3.5 versus 6.3 and 5.9 versus 7.6; both p < 0.05), as shown in Fig. 1b. In addition, muscle weakness assessed by MRC sum score and disability evaluated by HFGS indicated more severe disease severity in mechanically ventilated patients (Group MV) (MRC, 16.6 versus 41.0, p < 0.05; HFGS, 5 versus 3.0, p < 0.05; Fig. 1c and d).Table 1


Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome.

Wu X, Li C, Zhang B, Shen D, Li T, Liu K, Zhang HL - Crit Care (2015)

Comparisons between patients with and without mechanical ventilation. a The seasonal distribution in GBS occurrence was different between Group MV and Group NV. More GBS patients with mechanical ventilation were found in winter, while those without mechanical ventilation were more common in summer (both p < 0.05). b Time from onset to admission and time from onset to nadir were both shorter in Group MV (3.5 versus 6.3 and 5.9 versus 7.6; both p < 0.05). As assessed by c the MRC sum score and d HFGS, more severe disease severity was found in Group MV (MRC, 16.6 versus 41.0; HFGS, 5 versus 3.0; both p < 0.05). Group MV GBS patients with mechanical ventilation, Group NV GBS patients did not require mechanical ventilation, HFGS Hughes Functional Grading Scale, MRC Medical Research Council (sum score)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4557605&req=5

Fig1: Comparisons between patients with and without mechanical ventilation. a The seasonal distribution in GBS occurrence was different between Group MV and Group NV. More GBS patients with mechanical ventilation were found in winter, while those without mechanical ventilation were more common in summer (both p < 0.05). b Time from onset to admission and time from onset to nadir were both shorter in Group MV (3.5 versus 6.3 and 5.9 versus 7.6; both p < 0.05). As assessed by c the MRC sum score and d HFGS, more severe disease severity was found in Group MV (MRC, 16.6 versus 41.0; HFGS, 5 versus 3.0; both p < 0.05). Group MV GBS patients with mechanical ventilation, Group NV GBS patients did not require mechanical ventilation, HFGS Hughes Functional Grading Scale, MRC Medical Research Council (sum score)
Mentions: A total of 541 adult patients were enrolled. The mean age was 41.6 years with a male preponderance (61.2 %). Eighty (14.8 %) patients requiring MV during hospitalization were placed into Group MV, while the remaining 461 patients were in the Group NV. Comparisons between Group MV and Group NV are demonstrated in Table 1. We found that cranial nerve involvement was more common in Group MV (66.3 % versus 39.9 %, p < 0.05), as was a longer hospitalization period (38.7 versus 14.6, p < 0.05). Seasonal distribution was also significantly different between the two groups, as shown in Fig. 1a. More patients with MV (Group MV) were admitted in winter while more patients without MV (Group NV) were admitted in summer (both p < 0.05). Time from onset to admission and time from onset to nadir was both shorter in the Group MV (3.5 versus 6.3 and 5.9 versus 7.6; both p < 0.05), as shown in Fig. 1b. In addition, muscle weakness assessed by MRC sum score and disability evaluated by HFGS indicated more severe disease severity in mechanically ventilated patients (Group MV) (MRC, 16.6 versus 41.0, p < 0.05; HFGS, 5 versus 3.0, p < 0.05; Fig. 1c and d).Table 1

Bottom Line: Combined use of intravenous corticosteroids with intravenous immunoglobulin (odds ratio 10.200, 95% confidence interval 1.068-97.407, p < 0.05) was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection.Clinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct.Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.

View Article: PubMed Central - PubMed

Affiliation: Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China. wuxiujuan861003@126.com.

ABSTRACT

Introduction: Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system. Respiratory failure requiring mechanical ventilation (MV) is a serious complication of GBS. Identification of modifiable risk factors for MV and poor short-term prognosis in mechanically ventilated patients with GBS may contribute to the individualized management and may help improve the outcome of the patients.

Methods: We retrospectively analyzed the clinical data of 541 patients who were diagnosed with GBS from 2003 to 2014. Independent predictors for MV and short-term prognosis in mechanically ventilated patients were identified via multivariate logistic regression analysis.

Results: The mean age was 41.6 years with a male predilection (61.2%). Eighty patients (14.8%) required MV. Multivariate analysis revealed that shorter interval from onset to admission (p < 0.05), facial nerve palsy (p < 0.01), glossopharyngeal and vagal nerve deficits (p < 0.01) and lower Medical Research Council (MRC) sum score at nadir (p < 0.01) were risk factors for MV; disease occurrence in summer (p < 0.01) was a protective factor. As to prognostic factors, absence of antecedent infections (p < 0.01) and lower MRC sum score at nadir (p < 0.01) were predictors of poor short-term prognosis in mechanically ventilated patients regardless of treatment modality. We further investigated the predictors of poor short-term prognosis in patients requiring MV with different nadir MRC sum scores. Combined use of intravenous corticosteroids with intravenous immunoglobulin (odds ratio 10.200, 95% confidence interval 1.068-97.407, p < 0.05) was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection.

Conclusions: Clinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct. Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.

No MeSH data available.


Related in: MedlinePlus