Markers for Guillain‐Barré syndrome with poor prognosis: a multi‐center study

Abstract

Guillain-Barré syndrome (GBS) is an acute monophasic neuropathy. Prognostic tools include the modified Erasmus GBS outcome score (mEGOS), Erasmus GBS respiratory insufficiency score (EGRIS), and the increase in serum IgG levels (ΔIgG) 2 weeks after intravenous immunoglobulin (IVIg) treatment. Given that proportions of GBS subtypes differ between Western countries and Japan, the usefulness of these tools in Japan or other countries remains unknown. We enrolled 177 Japanese patients with GBS from 15 university hospitals and retrospectively obtained mEGOS and EGRIS for all and ΔIgG status for 79 of them. High mEGOS scores on admission or on day 7 were significantly associated with poorer outcomes (unable to walk independently at 6 months). High EGRIS scores (≥5 points) were associated with an increased risk for mechanical ventilation. Patients with ΔIgG <1,108 mg/dl had significantly poorer outcomes. We suggest that mEGOS, EGRIS, and ΔIgG in GBS are clinically relevant in Japan.

The utility of Guillain‐Barré syndrome prognostic models in Malaysian patients

“…Our results were consistent with findings from another Asian cohort in Japan . In comparison to the Japanese study, the mean mEGOS on admission (4) and day 7 of admission (5) in our cohort were higher than the Japanese patients (3 and 4, respectively).…”

“…In the current study, we also found EGRIS useful in our GBS population. Our findings were in keeping with the Japanese study, which found GBS patients with a higher score on EGRIS were more likely to require mechanical ventilation. Early identification of GBS patients in need of respiratory support is crucial as it allows treating clinicians to alert intensive care specialists and measures can be taken to escalate management to the intensive care unit where elective intubation could be considered.…”

“…However, the usefulness of this model remains unclear in other patient cohorts. In Japan, the authors found mEGOS helpful but in Brazil, the original EGOS was found to be less applicable . The EGRIS model has also been validated in the Netherlands and Japan and the model was useful in predicting the need for mechanical ventilation in the first week after admission in both populations …”

Second IVIg course in Guillain‐Barré syndrome patients with poor prognosis (SID‐GBS trial): Protocol for a double‐blind randomized, placebo‐controlled clinical trial

“…The mEGOS has very good predictive power (Area Under the Receiver Operating Characteristic [ROC] Curve [AUC] = 0.87) for prediction of outcome after 4 weeks, indicating very good discriminative ability. The mEGOS was recently validated in a Japanese cohort and performed equally good in this cohort, underlining the validity of the model . In the Second IVIg Dose‐Guillain‐Barre syndrome (SID‐GBS) trial an mEGOS score of at least 6 was used as a cutoff for poor prognosis.…”

Clinical and electrophysiological characteristics of Guillain‐Barré syndrome in Colombia

“…A study of 177 Japanese patients had a mean (SD) mEGOS score at admission of 3.3 (2.4), and at 6 months those who had a mean score of 3 were able to walk independently (89%) while those who had a mean score of 5.5 were unable to do it (11%). They also showed that with cutoffs between 5 and 7, the specificity of mEGOS to predict outcomes increased . This may suggest that most of our patients (66%) would have a more favorable recovery as they had a mEGOS score at admission of <5.…”