Clinical Profile and Predictors of Mechanical Ventilation in Guillain-Barre Syndrome in North Indian Children

Abstract

Objective: To describe the clinical-laboratory profile of pediatric Guillain-Barre syndrome and delineate features associated with need of mechanical ventilation. Methods: In a prospective observational study at tertiary care hospital, clinical-laboratory assessment and nerve conduction studies were documented in consecutive children hospitalized with Guillain-Barre syndrome according to Brighton criteria. Clinical-laboratory features were compared between ventilated and nonventilated patients using univariate and multivariate analysis. Results: Forty-six children (27 boys) with a mean age of 69.1±35.2 months were enrolled. History of preceding infection was present in 47.8%, bulbar palsy in 43.5%, feeble voice in 41.3%, sensory involvement in 13%, and autonomic involvement in 39.5%. Tetraparesis was noted in 87% of cases. Hughes disability scale >3 was noted in 44 children at admission and 39 (84.7%) at discharge. The most common electrophysiological type was acute motor axonal neuropathy (46.5%) followed by acute motor sensory axonal neuropathy (39.5%), acute inflammatory demyelinating polyneuropathy (7%), and inexcitable nerves (7%). Nine (19.7%) children were ventilated, 3 (6.5%) died or were lost, and 43 were discharged. Factors associated with need of mechanical ventilation on univariate analysis were older age, hypertension, bulbar palsy, feeble voice, lower Medical Research Council (MRC) sum, raised total leucocyte count, and history of preceding infection. Logistic regression revealed older age, history of predisposing illness, lower MRC sum at presentation, and bulbar palsy as independent predictors of mechanical ventilation. Conclusions: The most common electrophysiological subtype in northern Indian children is acute motor axonal neuropathy. Older age, preceding infection, low MRC sum, and bulbar palsy are predictors of mechanical ventilation in pediatric Guillain-Barre syndrome.

Role of the Neutrophil to Lymphocyte Ratio in Guillain Barré Syndrome: A Systematic Review and Meta-Analysis

“…After screening, 14 studies were included in the review [ 10 – 16 , 18 – 23 ]. Among them, ten studies had sufficient data to be included in the meta-analysis [ 10 – 16 , 22 , 24 , 25 ].…”

“…Of the ten studies included in this meta-analysis [ 10 – 16 , 22 , 24 , 25 ], eight studies were retrospective [ 10 – 12 , 14 – 16 , 24 , 25 ], and two studies were prospective [ 13 , 22 ]. Concerning document language, all of the documents were in English.…”

“…Of the ten studies, five studies compared pretreatment NLR levels in patients with GBS and those of controls [ 10 – 14 ], three studies compared posttreatment NLR levels in patients with GBS and those of controls [ 11 – 13 ], four studies compared pre- and posttreatment NLR levels in patients with GBS [ 11 – 13 , 15 ], three studies provided NLR data for both good and poor outcome patients [ 11 – 13 ], and three studies reported association of NLR with mechanical ventilation [ 22 , 24 , 25 ]. Additionally, five studies declared the differences in NLR levels between AIDP and axonal types [ 10 – 13 , 16 ], of which three studies showed the differences in NLR levels among AIDP, AMAN, and AMSAN [ 12 , 13 , 16 ].…”

“…In addition to the 228 studies found from the initial database search, 20 further studies were identified through reference lists of relevant articles and Google Scholar and were added. After screening, 14 studies were included in the review [10][11][12][13][14][15][16][18][19][20][21][22][23]. Among them, ten studies had sufficient data to be included in the metaanalysis [10-16, 22, 24, 25].…”

“…and three studies reported association of NLR with mechanical ventilation [22,24,25]. Additionally, five studies declared the differences in NLR levels between AIDP and axonal types [10][11][12][13]16], of which three studies showed the differences in NLR levels among AIDP, AMAN, and AMSAN [12,13,16].…”