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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

Distribution of mechanically ventilated patients with different nadir MRC sum scores. There were 40 patients with a nadir MRC sum score from 0 to 12 points, corresponding to muscle strength less than 1/5 grade. In addition, 12 patients with a nadir MRC sum score from 13 to 24 points, 13 with a nadir MRC sum score from 25 to 36 points, 5 with a nadir MRC sum score from 37 to 48 points, and 4 with a nadir MRC sum score from 49 to 60 points
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Fig3: Distribution of mechanically ventilated patients with different nadir MRC sum scores. There were 40 patients with a nadir MRC sum score from 0 to 12 points, corresponding to muscle strength less than 1/5 grade. In addition, 12 patients with a nadir MRC sum score from 13 to 24 points, 13 with a nadir MRC sum score from 25 to 36 points, 5 with a nadir MRC sum score from 37 to 48 points, and 4 with a nadir MRC sum score from 49 to 60 points

Mentions: We evaluated the effect of added steroid therapy to the outcome in patients with severe muscle weakness at nadir (40 patients, MRC sum score 0 to 12 points) (Fig. 3). These treatments consisted of IVIg therapy (16 cases), IVIg combined with intravenous corticosteroids (18 cases), intravenous corticosteroids alone (2 cases), or supportive treatment alone (4 cases). Only the combination therapy was an independent predictor of poor short-term prognosis regardless of the existence of antecedent infections in these patients (odds ratio 10.200, 95 % confidence interval 1.068–97.407, p < 0.05). Thus add-on use of intravenous corticosteroids predicted poor short-term prognosis in severely paralyzed patients requiring MV.Fig. 3


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)

Distribution of mechanically ventilated patients with different nadir MRC sum scores. There were 40 patients with a nadir MRC sum score from 0 to 12 points, corresponding to muscle strength less than 1/5 grade. In addition, 12 patients with a nadir MRC sum score from 13 to 24 points, 13 with a nadir MRC sum score from 25 to 36 points, 5 with a nadir MRC sum score from 37 to 48 points, and 4 with a nadir MRC sum score from 49 to 60 points
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Distribution of mechanically ventilated patients with different nadir MRC sum scores. There were 40 patients with a nadir MRC sum score from 0 to 12 points, corresponding to muscle strength less than 1/5 grade. In addition, 12 patients with a nadir MRC sum score from 13 to 24 points, 13 with a nadir MRC sum score from 25 to 36 points, 5 with a nadir MRC sum score from 37 to 48 points, and 4 with a nadir MRC sum score from 49 to 60 points
Mentions: We evaluated the effect of added steroid therapy to the outcome in patients with severe muscle weakness at nadir (40 patients, MRC sum score 0 to 12 points) (Fig. 3). These treatments consisted of IVIg therapy (16 cases), IVIg combined with intravenous corticosteroids (18 cases), intravenous corticosteroids alone (2 cases), or supportive treatment alone (4 cases). Only the combination therapy was an independent predictor of poor short-term prognosis regardless of the existence of antecedent infections in these patients (odds ratio 10.200, 95 % confidence interval 1.068–97.407, p < 0.05). Thus add-on use of intravenous corticosteroids predicted poor short-term prognosis in severely paralyzed patients requiring MV.Fig. 3

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