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Risk Factors for Mechanical Ventilation in Patients with Guillain–Barré Syndrome

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Abstract

Background

Respiratory support is required in 20–30% of patients with Guillain–Barré syndrome (GBS). We investigated clinical and biological risk factors for mechanical ventilation (MV) in northeast China through a retrospective GBS study. The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is a prognostic model for MV in patients with GBS, and its usefulness has been validated in several countries but not in China. Therefore, we intended to validate the EGRIS model in our GBS cohort.

Methods

A total of 252 patients with GBS were included in this study from January 2013 to October 2017. Risk factors for MV were identified via multivariate logistic regression analysis. The prognostic value of the EGRIS was validated via receiver operating characteristic curve analysis.

Results

Thirty-one patients (12.3%) required MV (mean age 54.19 years), with a majority being male (77.4%). The risk factors for MV were male sex [odds ratio (OR) 3.720, 95% confidence interval (CI) 1.155–11.985, p < 0.05], shorter interval from onset to admission (OR 0.830, 95% CI 0.711–0.970, p < 0.05), lower Medical Research Council sum score at admission (OR 0.942, 95% CI 0.911–0.973, p < 0.001), neutrophil-to-lymphocyte ratio at admission (OR 1.174, 95% CI 1.049–1.315, p < 0.01), and cranial nerve deficit (OR 3.805, 95% CI 1.373–10.541, p < 0.05). The EGRIS had a good predictive ability for MV (area under the receiver operating curve 0.861) in patients with GBS, and a high EGRIS was a predictor for MV (OR 8.778, 95% CI 3.432–22.448, p < 0.001). However, there was no significant difference in ganglioside administration between ventilated and nonventilated patients.

Conclusions

An elevated neutrophil-to-lymphocyte ratio at admission and a high EGRIS could serve as predictors for MV in our GBS cohort.

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References

  1. Wu X, Wu W, Wang Z, et al. More severe manifestations and poorer short-term prognosis of ganglioside-associated Guillain–Barré syndrome in Northeast China. PLoS ONE. 2014;9(8):e104074.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wakerley BR, Yuki N. Infectious and noninfectious triggers in Guillain–Barre syndrome. Expert Rev Clin Immunol. 2013;9(7):627–39.

    Article  CAS  PubMed  Google Scholar 

  3. Figueras A, Morales-Olivas FJ, Capellà D, Palop V, Laporte JR. Bovine gangliosides and acute motor polyneuropathy. BMJ. 1992;305(6865):1330–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Willison HJ, Jacobs BC, van Doorn PA. Guillain–Barré syndrome. The Lancet. 2016;388(10045):717–27.

    Article  Google Scholar 

  5. Islam Z, Papri N, Ara G, et al. Risk factors for respiratory failure in Guillain-Barre syndrome in Bangladesh: a prospective study. Ann Clin Transl Neurol. 2019;6(2):324–32.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Green C, Baker T, Subramaniam A. Predictors of respiratory failure in patients with Guillain-Barre syndrome: a systematic review and meta-analysis. Med J Aust. 2018;208(4):181–8.

    Article  PubMed  Google Scholar 

  7. Durand M-C, Porcher R, Orlikowski D, et al. Clinical and electrophysiological predictors of respiratory failure in Guillain–Barré syndrome: a prospective study. Lancet Neurol. 2006;5(12):1021–8.

    Article  PubMed  Google Scholar 

  8. Wu X, Li C, Zhang B, et al. Predictors for mechanical ventilation and short-term prognosis in patients with Guillain–Barre syndrome. Crit Care. 2015;19:310.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Haifeng L. Anti-GQ1b antibody as a factor predictive of mechanical ventilation in Guillain–Barre syndrome. Neurology. 2004;63(10):1985.

    Article  PubMed  Google Scholar 

  10. Durand MC, Lofaso F, Lefaucheur JP, et al. Electrophysiology to predict mechanical ventilation in Guillain–Barré syndrome. Eur J Neurol. 2003;10(1):39–44.

    Article  PubMed  Google Scholar 

  11. Kannan Kanikannan MA, Durga P, Venigalla NK, et al. Simple bedside predictors of mechanical ventilation in patients with Guillain–Barre syndrome. J Crit Care. 2014;29(2):219–23.

    Article  PubMed  Google Scholar 

  12. Walgaard C, Lingsma HF, Ruts L, et al. Prediction of respiratory insufficiency in Guillain–Barre syndrome. Ann Neurol. 2010;67(6):781–7.

    PubMed  Google Scholar 

  13. Yamagishi Y, Suzuki H, Sonoo M, et al. Markers for Guillain–Barre syndrome with poor prognosis: a multi-center study. J Peripher Nerv Syst. 2017;22(4):433–9.

    Article  CAS  PubMed  Google Scholar 

  14. Tan CY, Razali SNO, Goh KJ, Shahrizaila N. The utility of Guillain–Barre syndrome prognostic models in Malaysian patients. J Peripher Nerv Syst. 2019;24(2):168–73.

    Article  PubMed  Google Scholar 

  15. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain–Barré syndrome. Ann Neurol. 1990;27(Suppl):S21–4.

    Article  PubMed  Google Scholar 

  16. Hughes RAC, Cornblath DR. Guillain–Barré syndrome. Lancet. 2005;366(9497):1653–66.

    Article  CAS  PubMed  Google Scholar 

  17. Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute polyneuropathy. Lancet. 1978;2(8093):750–3.

    Article  CAS  PubMed  Google Scholar 

  18. Kleyweg RP, van der Meché FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain–Barré syndrome. Muscle Nerve. 1991;14(11):1103–9.

    Article  CAS  PubMed  Google Scholar 

  19. Sharshar T, Chevret S, Bourdain F, Raphaël JC. Early predictors of mechanical ventilation in Guillain–Barré syndrome. Crit Care Med. 2003;31(1):278–83.

    Article  PubMed  Google Scholar 

  20. Ning P, Yang B, Yang X, et al. A nomogram to predict mechanical ventilation in Guillain–Barre syndrome patients. Acta Neurol Scand. 2020;142(5):466–74.

    Article  CAS  PubMed  Google Scholar 

  21. Paul BS, Bhatia R, Prasad K, et al. Clinical predictors of mechanical ventilation in Guillain–Barre syndrome. Neurol India. 2012;60(2):150–3.

    Article  PubMed  Google Scholar 

  22. Omichi K, Cloyd JM, Yamashita S, et al. Neutrophil-to-lymphocyte ratio predicts prognosis after neoadjuvant chemotherapy and resection of intrahepatic cholangiocarcinoma. Surgery. 2017;162(4):752–65.

    Article  PubMed  Google Scholar 

  23. Qun S, Tang Y, Sun J, et al. Neutrophil-to-lymphocyte ratio predicts 3-month outcome of acute ischemic stroke. Neurotox Res. 2017;31(3):444–52.

    Article  PubMed  Google Scholar 

  24. Diniz LR, de Lima SG, de Amorim Garcia JM, de Oliveira Diniz KL. Neutrophil to lymphocyte ratio as a prognostic predictor in older people with acute coronary syndrome. Angiology. 2019;70(3):264–71.

    Article  PubMed  Google Scholar 

  25. Ozdemir HH. Analysis of the albumin level, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio in Guillain–Barre syndrome. Arq Neuropsiquiatr. 2016;74(9):718–22.

    Article  PubMed  Google Scholar 

  26. Huang Y, Ying Z, Quan W, et al. The clinical significance of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in Guillain–Barre syndrome. Int J Neurosci. 2018;128(8):729–35.

    Article  PubMed  Google Scholar 

  27. Tunc A. Early predictors of functional disability in Guillain–Barre syndrome. Acta Neurol Belg. 2019;119(4):555–9.

    Article  PubMed  Google Scholar 

  28. Huner EA, Dai AI, Demiryurek AT. Association of neutrophil/lymphocyte ratio with intravenous immunoglobulin treatment in children with Guillain–Barre syndrome. J Child Neurol. 2018;33(2):164–7.

    Article  PubMed  Google Scholar 

  29. Capone M, Giannarelli D, Mallardo D, et al. Baseline neutrophil-to-lymphocyte ratio (NLR) and derived NLR could predict overall survival in patients with advanced melanoma treated with nivolumab. J Immunother Cancer. 2018;6(1):74.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shang P, Zhu M, Baker M, et al. Mechanical ventilation in Guillain–Barre syndrome. Expert Rev Clin Immunol. 2020;16(11):1053–64.

    Article  CAS  PubMed  Google Scholar 

  31. Liu S, Xiao Z, Lou M, et al. Guillain–Barré syndrome in southern China: retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River. J Neurol Neurosurg Psychiatr. 2018;89(6):618–26.

    Article  Google Scholar 

  32. Kalita J, Ranjan A, Misra UK. Outcome of Guillain–Barre syndrome patients with respiratory paralysis. QJM. 2016;109(5):319–23.

    Article  CAS  PubMed  Google Scholar 

  33. Walgaard C, Lingsma HF, van Doorn PA, et al. Tracheostomy or not: prediction of prolonged mechanical ventilation in Guillain–Barré Syndrome. Neurocrit Care. 2017;26(1):6–13.

    Article  PubMed  Google Scholar 

  34. Shi M, Zhu J, Deng H. Clinical characteristics of intravenous injection of monosialotetrahexosyl ganglioside sodium-related Guillain–Barre syndrome. Front Neurol. 2019;10:225.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Govoni V, Granieri E, Manconi M, Capone J, Casetta I. Is there a decrease in Guillain-Barré syndrome incidence after bovine ganglioside withdrawal in Italy? A population-based study in the Local Health District of Ferrara, Italy. J Neurol Sci. 2003;216(1):99–103.

    Article  CAS  PubMed  Google Scholar 

  36. Latov N, Koski CL, Walicke PA, Schönhöfer PS. Guillain–Barré syndrome and parenteral gangliosides. Lancet. 1991;338(8769):757.

    Article  Google Scholar 

  37. Illa I, Ortiz N, Gallard E, et al. Acute axonal Guillain–Barré syndrome with IgG antibodies against motor axons following parenteral gangliosides. Ann Neurol. 1995;38(2):218–24.

    Article  CAS  PubMed  Google Scholar 

  38. Funes SC, Chiari ME, Comín R, Irazoqui FJ, Nores GA. Experimental Guillain-Barre syndrome induced by immunization with gangliosides: keyhole limpet hemocyanin is required for disease triggering. Biochim Biophys Acta Mol Basis Dis. 2017;1863(6):1473–8.

    Article  CAS  PubMed  Google Scholar 

  39. Asthana P, Vong JS, Kumar G, et al. Dissecting the role of anti-ganglioside antibodies in Guillain–Barré syndrome: an animal model approach. Mol Neurobiol. 2016;53(7):4981–91.

    Article  CAS  PubMed  Google Scholar 

  40. Yuki N, Yamada M, Koga M, et al. Animal model of axonal Guillain–Barré syndrome induced by sensitization with GM1 ganglioside. Ann Neurol. 2001;49(6):712–20.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We are grateful to all study participants and the staff from the First Hospital of Jilin University for their contributions to this study. The authors also thank Yuqin Ye for her assistance in the electrophysiological examination and classification.

Funding

The work was supported by grants from the Young Scholars Program of the First Hospital of Jilin University (Grant No. JDYY82017029).

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Authors and Affiliations

  1. Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, China

    Yanwei Cheng, Kangding Liu, Chunrong Li, Weiwei Zhang, Xiujuan Wu & Shaokuan Fang

Authors
  1. Yanwei Cheng
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  2. Kangding Liu
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  3. Chunrong Li
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  4. Weiwei Zhang
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  5. Xiujuan Wu
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  6. Shaokuan Fang
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Contributions

XW and SF conceived and directed this study. YC, CL and WZ collected the clinical data. YC and KL analyzed the data and wrote the manuscript. XW and SF re-performed all the data analyses and revised the manuscript. All authors have read and approved the final version of the manuscript and agreed to submit it for publication.

Corresponding authors

Correspondence to Xiujuan Wu or Shaokuan Fang.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval/Informed Consent

This study received approval from the institutional review board of the First Hospital of Jilin University. For this type of study, formal consent was not required. Because of the retrospective nature of this study, informed consent was waived.

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Cheng, Y., Liu, K., Li, C. et al. Risk Factors for Mechanical Ventilation in Patients with Guillain–Barré Syndrome. Neurocrit Care 37, 121–128 (2022). https://doi.org/10.1007/s12028-022-01457-8

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