Incidence, Disability, and Mortality in Patients With Guillain-Barré Syndrome in Korea: A Nationwide Population-Based Study

Yi, Sang-Wook; Lee, Jung Hwan; Hong, Ji‐Man; Choi, Young Chul; Park, Hyung Jun

doi:10.3988/jcn.2022.18.1.48

Cited by 8 publications

(13 citation statements)

References 49 publications

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“…Previous longitudinal epidemiological studies on GBS incidence in South Korea have suggested a peak incidence in the late spring to summer months. 10 However, in our analysis, we observed a double peak during the prepandemic era: from late spring to summer and in the winter months. Although the late spring to summer peak was maintained during the pandemic period, likely due to a lesser decrease in gastrointestinal infections (especially from bacterial pathogens), the winter peak diminished in 2021, likely due to a substantial decrease in the outbreak of respiratory infections, which mostly tended to have a peak incidence during the winter in South Korea ( figure 2A and table 1 ).…”

Section: Discussioncontrasting

confidence: 52%

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Deciphering changes in the incidence of the Guillain-Barré syndrome during the COVID-19 pandemic: a nationwide time-series correlation study

et al. 2022

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BackgroundPostinfectious autoimmunity is a hallmark of Guillain-Barré syndrome (GBS), and GBS incidence closely parallels that of its immune triggers. Sociobehavioural interventions implemented during the COVID-19 pandemic have altered the infectious disease landscape.MethodsThis nationwide time-series correlation study analysed GBS incidence, sentinel surveillance and SARS-CoV-2 vaccination data from January 2017 to December 2021 in the National Health Insurance Service and Korean Disease Control and Prevention Agency databases. The incidence of GBS and sentinel gastrointestinal and respiratory infectious diseases during the pandemic (2020–2021) was estimated and compared with both prepandemic (2017–2019) and incidence predicted in a time-series forecasting model. Time-series correlation analysis was used to examine the temporal association between GBS, infectious triggers and SARS-CoV-2 vaccination.ResultsDuring the pandemic, the total crude cumulative incidence rate was 2.1 per 100 000 population, which is lower than the prepandemic incidence, especially in age groups of less than 60 years. Seasonality was briefly interrupted during the winter of 2021. The majority of respiratory and some gastrointestinal conditions had a lower-than-expected incidence during the pandemic. Compared with the prepandemic state, during the pandemic period a higher number of gastrointestinal pathogens (Escherichia coli,Campylobacterspp., Clostridium perfringens, Yersinia enterocoliticaand enteric adenovirus) had significant, moderate-to-strong positive temporal associations with GBS. The temporal association between SARS-CoV-2 infection and GBS was not significant, but SARS-CoV-2 vaccination exhibited a strong positive temporal association with GBS in 2021.ConclusionThe incidence of GBS and sentinel infectious diseases decreased to below-expected levels during the pandemic, with the former attributable to the decreased incidence of non-COVID-19 respiratory and gastrointestinal infections. The evolving incidence of autoimmune postinfectious phenomena following the pandemic needs attention.

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Section: Discussioncontrasting

confidence: 52%

“…In South Korea, GBS has consistently had a peak incidence in the late spring to summer months, similar to that in the summer peaks in the Indian subcontinent, Latin America and Northern China, whereas winter peaks are observed in Western countries and in the Middle East. 10 11 …”

Section: Introductionmentioning

confidence: 99%

Deciphering changes in the incidence of the Guillain-Barré syndrome during the COVID-19 pandemic: a nationwide time-series correlation study

et al. 2022

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“…As the pathogenesis of GBS is often explained by a post-infectious inflammatory response, a dramatic reduction in viral illnesses due to NPIs in the early stage of the pandemic could be a reason for the decline in GBS incidence. Previous studies validated the working definition of the first primary-coded GBS hospitalization as having a high positive predicted value (86% in a Danish nationwide study and 75% in a Korean nationwide study) (18,19). The GBS incidence in the pre-pandemic years (between 1.33 and 1.68 cases/100,000 persons/year) in our study was similar to that reported in prior epidemiological studies (1.24-1.77 cases/100,000 persons/year), indicating the reliability of our results in terms of incidence (18,20).…”

Section: Discussionmentioning

confidence: 95%

“…Previous studies validated the working definition of the first primary-coded GBS hospitalization as having a high positive predicted value (86% in a Danish nationwide study and 75% in a Korean nationwide study) (18,19). The GBS incidence in the pre-pandemic years (between 1.33 and 1.68 cases/100,000 persons/year) in our study was similar to that reported in prior epidemiological studies (1.24-1.77 cases/100,000 persons/year), indicating the reliability of our results in terms of incidence (18,20). We assessed the incidence of GBS and compared it with that in the pre-pandemic years using two methods.…”

Section: Discussionmentioning

confidence: 95%

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Incidence of Guillain–Barré syndrome in South Korea during the early COVID-19 pandemic

Choi

Hwang²,

Lim³

et al. 2023

Front. Neurol.

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ObjectivesGuillain–Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy, often triggered by infection. We aimed to investigate how the incidence of GBS changed in the early stages of the coronavirus 2019 (COVID-19) pandemic when nationwide infections declined due to non-pharmaceutical interventions.MethodsWe conducted a nationwide population-based retrospective GBS cohort study using data from the Health Insurance Review and Assessment Service of Korea. Patients with new-onset GBS were defined as those who were first hospitalized between 1 January 2016 and 31 December 2020 with an International Classification of Disease, 10th Revision code, for GBS (G61.0) as a primary diagnosis. The incidence of GBS in the pre-pandemic years (2016–2019) was compared with that in the first pandemic year (2020). Nationwide epidemiological data for infections were collected from the national infectious disease surveillance system. A correlation analysis was performed to determine the incidence of GBS and nationwide trends of various infections.ResultsOverall, 3,637 new-onset GBS cases were identified. The age-standardized incidence of GBS in the first pandemic year was 1.10 (95% confidence interval, 1.01–1.19) per 100,000 persons. Compared to the first pandemic year, the incidence of GBS during the pre-pandemic years (1.33–1.68/100,000 persons/year) was significantly higher, with incidence rate ratios of 1.21–1.53 (P < 0.001). Nationwide cases of upper respiratory viral infections were significantly reduced in the first pandemic year; however, Campylobacter infections peaked in the summer of the pandemic. The nationwide epidemiology of parainfluenza virus, enterovirus, and Campylobacter infections correlated positively with GBS incidence.ConclusionThe overall GBS incidence decreased in the early stages of the COVID-19 pandemic, which can be attributed to the dramatic reduction in viral illnesses due to public measures.

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Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome

et al. 2023

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Background Guillain–Barré syndrome (GBS) often carries a favorable prognosis. Of adult patients with GBS, 10–30% require mechanical ventilation during the acute phase of the disease. After the acute phase, the focus shifts to restoration of motor strength, ambulation, and neurological function, with variable speed and degree of recovery. The objective of these guidelines is to provide recommendations on the reliability of select clinical predictors that serve as the basis of neuroprognostication and provide guidance to clinicians counseling adult patients with GBS and/or their surrogates. Methods A narrative systematic review was completed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Candidate predictors, including clinical variables and prediction models, were selected based on clinical relevance and presence of appropriate body of evidence. The Population/Intervention/Comparator/Outcome/Time frame/Setting (PICOTS) question was framed as follows: “When counseling patients or surrogates of critically ill patients with Guillain–Barré syndrome, should [predictor, with time of assessment if appropriate] be considered a reliable predictor of [outcome, with time frame of assessment]?” Additional full-text screening criteria were used to exclude small and lower quality studies. Following construction of an evidence profile and summary of findings, recommendations were based on four GRADE criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use. In addition, good practice recommendations addressed essential principles of neuroprognostication that could not be framed in PICOTS format. Results Eight candidate clinical variables and six prediction models were selected. A total of 45 articles met our eligibility criteria to guide recommendations. We recommend bulbar weakness (the degree of motor weakness at disease nadir) and the Erasmus GBS Respiratory Insufficiency Score as moderately reliable for prediction of the need for mechanical ventilation. The Erasmus GBS Outcome Score (EGOS) and modified EGOS were identified as moderately reliable predictors of independent ambulation at 3 months and beyond. Good practice recommendations include consideration of both acute and recovery phases of the disease during prognostication, discussion of the possible need for mechanical ventilation and enteral nutrition during counseling, and consideration of the complete clinical condition as opposed to a single variable during prognostication. Conclusions These guidelines provide recommendations on the reliability of predictors of the need for mechanical ventilation, poor functional outcome, and independent ambulation following GBS in the context of counseling patients and/or surrogates and suggest broad principles of neuroprognostication. Few predictors were considered moderately reliable based on the available body of evidence, and higher quality data are needed.

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Incidence, Disability, and Mortality in Patients With Guillain-Barré Syndrome in Korea: A Nationwide Population-Based Study

Cited by 8 publications

References 49 publications

Deciphering changes in the incidence of the Guillain-Barré syndrome during the COVID-19 pandemic: a nationwide time-series correlation study

Deciphering changes in the incidence of the Guillain-Barré syndrome during the COVID-19 pandemic: a nationwide time-series correlation study

Incidence of Guillain–Barré syndrome in South Korea during the early COVID-19 pandemic

Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome

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