Prediction of respiratory insufficiency in Guillain‐Barré syndrome
- 25 May 2010
- journal article
- research article
- Published by Wiley in Annals of Neurology
- Vol. 67 (6), 781-787
- https://doi.org/10.1002/ana.21976
Abstract
Objective Respiratory insufficiency is a frequent and serious complication of the Guillain‐Barré syndrome (GBS). We aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the disease based on clinical characteristics available at hospital admission. Methods Mechanical ventilation (MV) in the first week of admission was used as an indicator of acute stage respiratory insufficiency. Prospectively collected data from a derivation cohort of 397 GBS patients were used to identify predictors of MV. A multivariate logistic regression model was validated in a separate cohort of 191 GBS patients. Model performance criteria comprised discrimination (area under receiver operating curve [AUC]) and calibration (graphically). A scoring system for clinical practice was constructed from the regression coefficients of the model in the combined cohorts. Results In the derivation cohort, 22% needed MV in the first week of admission. Days between onset of weakness and admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors of MV. The prognostic model had a good discriminative ability (AUC, 0.84). In the validation cohort, 14% needed MV in the first week of admission, and both calibration and discriminative ability of the model were good (AUC, 0.82). The scoring system ranged from 0 to 7, with corresponding chances of respiratory insufficiency from 1 to 91%. Interpretation This model accurately predicts development of respiratory insufficiency within 1 week in patients with GBS, using clinical characteristics available at admission. After further validation, the model may assist in clinical decision making, for example, on patient transfer to an intensive care unit. ANN NEUROL 2010;67:781–787Keywords
This publication has 31 references indexed in Scilit:
- Tongue weakness is associated with respiratory failure in patients with severe Guillain-Barré syndromeActa Neurologica Scandinavica, 2009
- Clinical predictors of mechanical ventilation in Fisher/Guillain-Barre overlap syndromeJournal of Neurology, Neurosurgery & Psychiatry, 2008
- National Trends in Hospital Outcomes Among Patients with Guillain-Barré Syndrome Requiring Mechanical VentilationJournal of Clinical Neuromuscular Disease, 2008
- Treatment of Guillain Barre syndrome with mycophenolate mofetil: a pilot studyJournal of Neurology, Neurosurgery & Psychiatry, 2007
- Predictive Factors and Long-Term Outcome of Respiratory Failure after Guillain-Barré SyndromeThe American Journal of the Medical Sciences, 2004
- Anti-ganglioside antibodies and clinical outcome of patients with Guillain-Barré Syndrome in northeast BrazilActa Neurologica Scandinavica, 2003
- Early predictors of mechanical ventilation in Guillain-Barré syndromeCritical Care Medicine, 2003
- Electrophysiological classification of guillain‐barré syndrome: Clinical associations and outcomeAnnals of Neurology, 1998
- The prognosis and main prognostic indicators of Guillain-Barré syndrome A multicentre prospective study of 297 patientsBrain, 1996
- Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain‐Barré syndromeMuscle & Nerve, 1991