Early Prediction Factors of Poor Outcome in Guillain-Barre Syndrome

ABSTRACT

OBJECTIVE: Guillain-Barre syndrome (GBS) is an acute post-infectious immune-mediated peripheral neuropathy with a variable clinical course and outcome. Identifying patients with poor outcome in the early stage might provide an opportunity for more effective and aggressive treatment and better prognosis. We aimed to determine early clinical factors associated with poor functional outcome in GBS. METHODS: Forty-seven patients with GBS were enrolled and followed up at Dongguk University Ilsan Hospital during May 2005–June 2015. Data collected retrospectively were used to identify risk factors of being unable to walk at 6 months. Potential predictors of poor outcome at 6 months were analyzed. RESULTS: Older age (≥55 years, P=0.002), low Medical Research Council (MRC) scale sum score (P=0.001), high GBS disability score (P=0.042), respiratory failure (P=0.042), severe weakness unable to walk (P=0.005), or voiding difficulty (P=0.001) at hospital ad-mission were associated with being unable to walk at 6 months. Preceding infections, subtype of acute motor axonal neuropathy (AMAN), and existence of GM1 antibody were not associated with poor prognosis in our study. CONCLUSION: Our study confirmed that the poor outcome is associated with older age, severity indicated by GBS disability score or MRC sum score, and ventilator support or walking disability at admission, but was not consistent with the previous literatures reporting preceding infection, AMAN subtype, and GM1 antibody as poor prognostic factors. Our study identified initial voiding difficulty as a novel poor prognostic factor, which implicates severe involvement of sacral roots.