We aimed to determine long-term disability and quality of life in patients with Guillain–Barré syndrome (GBS) who required mechanical ventilation (MV) in the acute phase. Our retrospective cohort study included 110 GBS patients admitted to an intensive care unit and requiring MV (01/1999–08/2010) in nine German tertiary academic medical centers. Outcome was determined 1 year or longer after hospital admission using the GBS disability scale, Barthel index (BI), EuroQuol-5D (EQ-5D) and Fatigue Severity Scale. Linear/multivariate regression analysis was used to analyze predicting factors for outcome. Mean time to follow up was 52.6 months. Hospital mortality was 5.5 % and long-term mortality 13.6 %. Overall 53.8 % had a favorable outcome (GBS disability score 0–1) and 73.7 % of survivors had no or mild disability (BI 90–100). In the five dimensions of the EQ-5D “mobility”, “self-care”, “usual activities”, “pain” and “anxiety/depression” no impairments were stated by 50.6, 58.4, 36.4, 36.4 and 50.6 % of patients, respectively. A severe fatigue syndrome was present in 30.4 % of patients. Outcome was statistically significantly correlated with age, type of therapy and number of immunoglobulin courses. In GBS-patients requiring MV in the acute phase in-hospital, and long-term mortality are lower than that in previous studies, while long-term quality of life is compromised in a large fraction of patients, foremost by immobility and chronic pain. Efforts towards improved treatment approaches should address autonomic dysfunction to further reduce hospital mortality while improved rehabilitation concepts might ameliorate long-term disability.
Guillain–Barré syndrome Peripheral neuropathy Critical care Outcome research Mortality Quality of life
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The authors wish to thank Miriam Bauer and Dominik Diesing (both Charité Center for Stroke Research Berlin) for technical support, Olivia Rudnicki (University of Erlangen) for data acquisition and Catherine Aubel (Charité Center for Stroke Research Berlin) for language editing of the final manuscript.
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
This study has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in 1964 Declaration of Helsinki.
Fletcher DD, Lawn ND, Wolter TD, Wijdicks EF (2000) Long-term outcome in patients with Guillain–Barré syndrome requiring mechanical ventilation. Neurology 54:2311–2315PubMedCrossRefGoogle Scholar
Henderson RD, Lawn ND, Fletcher DD, McClelland RL, Wijdicks EF (2003) The morbidity of Guillain–Barré syndrome admitted to the intensive care unit. Neurology 60:17–21PubMedCrossRefGoogle Scholar
Kohrmann M, Huttner HB, Nowe T, Schellinger PD, Schwab S (2009) Mechanical ventilation in Guillain–Barré syndrome: does age influence functional outcome? Eur Neurol 61:358–363PubMedCrossRefGoogle Scholar
Kiphuth IC, Schellinger PD, Kohrmann M et al (2010) Predictors for good functional outcome after neurocritical care. Crit Care 14:R136PubMedCrossRefGoogle Scholar
Ng KK, Howard RS, Fish DR et al (1995) Management and outcome of severe Guillain–Barré syndrome. QJM 88:243–250PubMedGoogle Scholar
Merkies IS, Schmitz PI, Samijn JP, van der Meche FG, van Doorn PA (1999) Fatigue in immune-mediated polyneuropathies. European Inflammatory Neuropathy Cause and Treatment (INCAT) Group. Neurology 53:1648–1654PubMedCrossRefGoogle Scholar
Garssen MP, Bussmann JB, Schmitz PI et al (2004) Physical training and fatigue, fitness, and quality of life in Guillain–Barré syndrome and CIDP. Neurology 63:2393–2395PubMedCrossRefGoogle Scholar
Dornonville de la Cour C, Jakobsen J (2005) Residual neuropathy in long-term population-based follow-up of Guillain–Barré syndrome. Neurology 64:246–253PubMedCrossRefGoogle Scholar
Chio A, Cocito D, Leone M, Giordana MT, Mora G, Mutani R (2003) Guillain–Barré syndrome: a prospective, population-based incidence and outcome survey. Neurology 60:1146–1150PubMedCrossRefGoogle Scholar
Bernsen RA, de Jager AE, Schmitz PI, van der Meche FG (1999) Residual physical outcome and daily living 3 to 6 years after Guillain–Barré syndrome. Neurology 53:409–410PubMedCrossRefGoogle Scholar
Rudolph T, Larsen JP, Farbu E (2008) The long-term functional status in patients with Guillain–Barré syndrome. Eur J Neurol 15:1332–1337PubMedCrossRefGoogle Scholar
Nagashima T, Nishimoto Y, Hirata K, Yuki N (2004) Outcome after Guillain–Barré syndrome: comparison of motor function status and changes in social life. Rinsho Shinkeigaku 44:50–53PubMedGoogle Scholar
Vedeler CA, Wik E, Nyland H (1997) The long-term prognosis of Guillain–Barré syndrome. Evaluation of prognostic factors including plasma exchange. Acta Neurol Scand 95:298–302PubMedCrossRefGoogle Scholar
Koeppen S, Kraywinkel K, Wessendorf TE et al (2006) Long-term outcome of Guillain–Barré syndrome. Neurocrit Care 5:235–242PubMedCrossRefGoogle Scholar
Davidson I, Wilson C, Walton T, Brissenden S, Campbell M, McGowan L (2010) What constitutes a ‘good’ recovery outcome in post-acute Guillain–Barré syndrome? Results of a nationwide survey of post-acute GBS sufferers in the United Kingdom. Eur J Neurol 17:677–683PubMedCrossRefGoogle Scholar
Bersano A, Carpo M, Allaria S, Franciotta D, Citterio A, Nobile-Orazio E (2006) Long term disability and social status change after Guillain–Barré syndrome. J Neurol 253:214–218PubMedCrossRefGoogle Scholar
Bernsen RA, de Jager AE, Schmitz PI, van der Meche FG (2002) Long-term impact on work and private life after Guillain–Barré syndrome. J Neurol Sci 201:13–17PubMedCrossRefGoogle Scholar
Dhar R, Stitt L, Hahn AF (2008) The morbidity and outcome of patients with Guillain–Barré syndrome admitted to the intensive care unit. J Neurol Sci 264:121–128PubMedCrossRefGoogle Scholar
Asbury AK, Cornblath DR (1990) Assessment of current diagnostic criteria for Guillain–Barré syndrome. Ann Neurol 27(Suppl):S21–S24PubMedCrossRefGoogle Scholar
Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM (1978) Controlled trial prednisolone in acute polyneuropathy. Lancet 2:750–753PubMedCrossRefGoogle Scholar
Mahoney FI, Barthel DW (1965) Functional Evaluation: The Barthel Index. Md State Med J 14:61–65PubMedGoogle Scholar
Heuschmann PU, Kolominsky-Rabas PL, Nolte CH et al (2005) The reliability of the german version of the Barthel-index and the development of a postal and telephone version for the application on stroke patients. Fortschr Neurol Psychiatr 73:74–82PubMedCrossRefGoogle Scholar
The EuroQol Group (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16:199–208CrossRefGoogle Scholar
Wu AW, Jacobson DL, Berzon RA et al (1997) The effect of mode of administration on medical outcomes study health ratings and EuroQol scores in AIDS. Qual Life Res 6:3–10PubMedGoogle Scholar
Puhan MA, Ahuja A, Van Natta ML, Ackatz LE, Meinert C (2011) Interviewer versus self-administered health-related quality of life questionnaires—does it matter? Health Qual Life Outcomes 9:30PubMedCrossRefGoogle Scholar
Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123PubMedCrossRefGoogle Scholar
Valko PO, Bassetti CL, Bloch KE, Held U, Baumann CR (2008) Validation of the fatigue severity scale in a Swiss cohort. Sleep 31:1601–1607PubMedGoogle Scholar
Konig HH, Bernert S, Angermeyer MC (2005) Health Status of the German population: results of a representative survey using the EuroQol questionnaire. Gesundheitswesen 67:173–182PubMedCrossRefGoogle Scholar
Ali MI, Fernandez-Perez ER, Pendem S, Brown DR, Wijdicks EF, Gajic O (2006) Mechanical ventilation in patients with Guillain–Barré syndrome. Respir Care 51:1403–1407PubMedGoogle Scholar
Netto AB, Taly AB, Kulkarni GB, Uma Maheshwara Rao GS, Rao S (2011) Prognosis of patients with Guillain–Barré syndrome requiring mechanical ventilation. Neurol India 59:707–711PubMedCrossRefGoogle Scholar
Farcas P, Avnun L, Frisher S, Herishanu YO, Wirguin I (1997) Efficacy of repeated intravenous immunoglobulin in severe unresponsive Guillain–Barré syndrome. Lancet 350:1747PubMedCrossRefGoogle Scholar