Diagnostic accuracy and mechanical ventilation risk in Guillain-Barré syndrome

Abstract

Introduction. Guillain-Barré syndrome (GBS) can assume regional variations based on antecedent illness exposure, clinical manifestations, and prognosis. Nonetheless, evidence of GBS heterogeneity in Brazil is still lacking. Objective. To determine GBS characteristics including predisposing factors, diagnostic accuracy, risk of mechanical ventilation and compare the results with other regional and international epidemiological studies. Method. In this retrospective cross-sectional study, we conducted a documental search for patients treated for GBS. After the assessment of diagnostic reliability using Brighton Criteria, data were collected using medical record review by expert neurologists. We compared predicted risk for mechanical ventilation using the Erasmus GBS Respiratory Insufficiency Score (EGRIS) and patient observed outcome within the first week. Results. In all, 33 patients were included, with reasonable diagnostic accuracy in most patients (75%). 15.2% of patients required mechanical ventilation. There was a positive association (p=0.013) between non-high risk and the absence of need for mechanical ventilation. The most common immune trigger was gastroenteritis (30.3%), followed by upper airway infection (15.2%). Conclusions. This study provides the first evidence that EGRIS may be used to identify patients with low risk for mechanical ventilation in a Brazilian sample. Prospective cohort studies are needed to confirm this finding. Clinical and epidemiological characteristics of patients are consistent with other Latin America observational studies, except on the predominance of gastroenteritis as a major immune trigger, as also observed in Brazilian Federal District, in Lima and Bangladesh.