Skip to main content

Long-term outcome in patients with Guillain–Barré syndrome requiring mechanical ventilation

Journal of Neurology volume 260, pages 1367–1374 (2013)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Winer JB, Hughes RA, Greenwood RJ, Perkin GD, Healy MJ (1985) Prognosis in Guillain–Barré syndrome. Lancet 1:1202–1203

    PubMed  Article  CAS  Google Scholar 

  2. Fletcher DD, Lawn ND, Wolter TD, Wijdicks EF (2000) Long-term outcome in patients with Guillain–Barré syndrome requiring mechanical ventilation. Neurology 54:2311–2315

    PubMed  Article  CAS  Google Scholar 

  3. Henderson RD, Lawn ND, Fletcher DD, McClelland RL, Wijdicks EF (2003) The morbidity of Guillain–Barré syndrome admitted to the intensive care unit. Neurology 60:17–21

    PubMed  Article  CAS  Google Scholar 

  4. Kohrmann M, Huttner HB, Nowe T, Schellinger PD, Schwab S (2009) Mechanical ventilation in Guillain–Barré syndrome: does age influence functional outcome? Eur Neurol 61:358–363

    PubMed  Article  Google Scholar 

  5. Lawn ND, Wijdicks EF (1999) Fatal Guillain–Barré syndrome. Neurology 52:635–638

    PubMed  Article  CAS  Google Scholar 

  6. Kiphuth IC, Schellinger PD, Kohrmann M et al (2010) Predictors for good functional outcome after neurocritical care. Crit Care 14:R136

    PubMed  Article  Google Scholar 

  7. Ng KK, Howard RS, Fish DR et al (1995) Management and outcome of severe Guillain–Barré syndrome. QJM 88:243–250

    PubMed  CAS  Google Scholar 

  8. 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 53:1648–1654

    PubMed  Article  CAS  Google Scholar 

  9. 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 63:2393–2395

    PubMed  Article  CAS  Google Scholar 

  10. Dornonville de la Cour C, Jakobsen J (2005) Residual neuropathy in long-term population-based follow-up of Guillain–Barré syndrome. Neurology 64:246–253

    PubMed  Article  Google Scholar 

  11. 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 60:1146–1150

    PubMed  Article  CAS  Google Scholar 

  12. 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 53:409–410

    PubMed  Article  CAS  Google Scholar 

  13. Rudolph T, Larsen JP, Farbu E (2008) The long-term functional status in patients with Guillain–Barré syndrome. Eur J Neurol 15:1332–1337

    PubMed  Article  CAS  Google Scholar 

  14. 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 44:50–53

    PubMed  Google Scholar 

  15. 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 95:298–302

    PubMed  Article  CAS  Google Scholar 

  16. Koeppen S, Kraywinkel K, Wessendorf TE et al (2006) Long-term outcome of Guillain–Barré syndrome. Neurocrit Care 5:235–242

    PubMed  Article  CAS  Google Scholar 

  17. 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 17:677–683

    PubMed  Article  CAS  Google Scholar 

  18. 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 253:214–218

    PubMed  Article  CAS  Google Scholar 

  19. 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 201:13–17

    PubMed  Article  Google Scholar 

  20. 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 264:121–128

    PubMed  Article  Google Scholar 

  21. Asbury AK, Cornblath DR (1990) Assessment of current diagnostic criteria for Guillain–Barré syndrome. Ann Neurol 27(Suppl):S21–S24

    PubMed  Article  Google Scholar 

  22. Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM (1978) Controlled trial prednisolone in acute polyneuropathy. Lancet 2:750–753

    PubMed  Article  CAS  Google Scholar 

  23. Mahoney FI, Barthel DW (1965) Functional Evaluation: The Barthel Index. Md State Med J 14:61–65

    PubMed  CAS  Google Scholar 

  24. 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 73:74–82

    PubMed  Article  CAS  Google Scholar 

  25. The EuroQol Group (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16:199–208

    Article  Google Scholar 

  26. 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 6:3–10

    PubMed  CAS  Google Scholar 

  27. 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 9:30

    PubMed  Article  Google Scholar 

  28. 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 46:1121–1123

    PubMed  Article  CAS  Google Scholar 

  29. Valko PO, Bassetti CL, Bloch KE, Held U, Baumann CR (2008) Validation of the fatigue severity scale in a Swiss cohort. Sleep 31:1601–1607

    PubMed  Google Scholar 

  30. Konig HH, Bernert S, Angermeyer MC (2005) Health Status of the German population: results of a representative survey using the EuroQol questionnaire. Gesundheitswesen 67:173–182

    PubMed  Article  CAS  Google Scholar 

  31. Ali MI, Fernandez-Perez ER, Pendem S, Brown DR, Wijdicks EF, Gajic O (2006) Mechanical ventilation in patients with Guillain–Barré syndrome. Respir Care 51:1403–1407

    PubMed  Google Scholar 

  32. 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 59:707–711

    PubMed  Article  Google Scholar 

  33. Farcas P, Avnun L, Frisher S, Herishanu YO, Wirguin I (1997) Efficacy of repeated intravenous immunoglobulin in severe unresponsive Guillain–Barré syndrome. Lancet 350:1747

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgments

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.

Ethical standard

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.

Author information

Authors and Affiliations

  1. Center for Stroke Research Berlin (CSB), Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany

    J. Witsch & E. Jüttler

  2. Department of Neurology, Charité University Medicine, Berlin, Germany

    J. Witsch

  3. Department of Neurology, University of Cologne, Cologne, Germany

    N. Galldiks

  4. Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Juelich, Germany

    N. Galldiks

  5. Department of Neurology, Ludwig-Maximilians-University, Munich, Germany

    A. Bender

  6. Department of Neurology, Therapiezentrum Burgau, Burgau, Germany

    A. Bender

  7. Department of Neurology, Friedrich-Alexander-University Erlangen, Erlangen, Germany

    R. Kollmar

  8. Department of Neurology, University of Heidelberg, Heidelberg, Germany

    J. Bösel

  9. Department of Neurology, University of Leipzig, Leipzig, Germany

    C. Hobohm

  10. Department of Neurology, University of Jena, Jena, Germany

    A. Günther

  11. Department of Neurology, University of Giessen, Giessen, Germany

    I. Schirotzek

  12. Department of Anesthesiology, University of Regensburg, Regensburg, Germany

    K. Fuchs

  13. Department of Neurology, Rehabilitation and University Hospitals Ulm, Ulm, Germany

    E. Jüttler

Authors
  1. J. Witsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Galldiks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Bender
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Kollmar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Bösel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Hobohm
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Günther
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. I. Schirotzek
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. K. Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. E. Jüttler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Witsch.

Additional information

For the Initiative of German NeuroIntensive Trial Engagement (IGNITE).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 73 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Witsch, J., Galldiks, N., Bender, A. et al. Long-term outcome in patients with Guillain–Barré syndrome requiring mechanical ventilation. J Neurol 260, 1367–1374 (2013). https://doi.org/10.1007/s00415-012-6806-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-012-6806-x

Keywords

  • Guillain–Barré syndrome
  • Peripheral neuropathy
  • Critical care
  • Outcome research
  • Mortality
  • Quality of life