Sodium Levels Predict Disability at Discharge in Guillain-Barré Syndrome: A Retrospective Cohort Study.

Delia Gagliardi,Manuel Alfredo Podestà,Roberta Brusa,Irene Faravelli,Alessio Di Fonzo,Sara Bonato,Stefania Corti,Elio Scarpini,Nereo Bresolin,Eleonora Mauri,Giacomo Pietro Comi,Domenica Saccomanno

doi:10.3389/fneur.2021.729252

Abstract

Guillain-Barré syndrome (GBS) is an inflammatory polyradiculopathy with potentially severe complications. Clinical tools for risk stratification have been developed, but no definitive prognostic biomarker has been reported. Hyponatremia is frequent in GBS patients, but the impact of serum sodium levels on clinical outcomes is still ill-defined. In this retrospective cohort study, we included all adult patients diagnosed with GBS spectrum disorders at our center from January 2010 to July 2020. Disability at discharge was assessed with the GBS Disability Score (GDS), and all clinical and laboratory data was retrieved from medical charts. Thirty (58.8%) of the 51 subjects included in the study were discharged with severe residual disability (GDS ≥ 3). After accounting for relevant confounders, the odds of experiencing severe disability decreased by 27% (p = 0.027) for each unitary increase in serum sodium concentration. Thirteen (25.5%) patients were diagnosed with mild to moderate hyponatremia; the use of intravenous immune globulin (IVIG) independently increased the odds of developing hyponatremia. In conclusion, we found a significant, independent association between baseline serum sodium levels and severe disability at discharge in GBS patients. In our cohort, hyponatremia was more frequently observed after treatment with IVIG, suggesting dilutional pseudohyponatremia as a probable cause.

Highlights

Guillain-Barré syndrome (GBS) is an inflammatory polyradiculopathy with a worldwide incidence of 100,000 cases per year, which can lead to permanent severe disability in a significant fraction of patients [1]
Disability was assessed with the GBS Disability Score (GDS), which ranges from 0 to 6; severe disability was defined by a GDS ≥ 3, i.e., inability to walk without assistance for 10 meters across an open space
In this retrospective cohort study, we have found a significant, independent association between baseline serum sodium levels and severe disability at discharge in subjects with GBS spectrum disorders

Summary

Introduction

Guillain-Barré syndrome (GBS) is an inflammatory polyradiculopathy with a worldwide incidence of 100,000 cases per year, which can lead to permanent severe disability in a significant fraction of patients [1]. Hyponatremia is one of the most frequent electrolyte abnormalities observed in hospitalized and critically-ill patients [3, 4], and sodium levels at admission have been found to predict mortality in various patient populations [5, 6]. The occurrence of hyponatremia in GBS patients has been first reported decades ago [7, 8], but the impact of serum sodium levels on clinical outcomes is still ill-defined [9, 10]. We have assessed sodium levels in a wellcharacterized monocentric cohort of GBS patients, in order to explore their association with clinical outcomes and potential causative determinants of hyponatremia during hospitalization

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