Analysis Of Risk Factors Of Respiratory Failure In Patients With Guillian-Barré Syndrome

Objectives: Respiratory failure is the most serious complication of GBS andmechanical ventilation is needed in20-30%of patients. Delaying mechanicalventilation leads to emergent endotracheal intubation and increases the risk of lifethreatening complications such as respiratory arrest and aspiration pneumonia. It istherefore important to identify risk factors for respiratory failure. Previous studiesidentified various risk factors for respiratory failure in GBS, including history ofpreceding diarrhea, rapid progressive motor weakness, disability severity on admission,cranial nerve involvement, autonomic dysfunction, electrophysiological features ofnerve conduction block, decreased vital capacity, serum anti-GQ1b IgG antibodies, andincreased liver enzymes. However, the predict value of these indicators is stillcontroversial. The aim of the present study was to compare epidemiological, clinical,and laboratory features among GBS patients with or without respiratory failure, and todeterminate simple but valid clinical parameters enable early prediction of individualpatient risk of respiratory failure.Methods: A retrospective review of medical records of237consecutive patientswith GBS admitted into our neurology ward in the First Affiliated Hospital of DalianMedical University between January2002and December2011was performed. Wecollected data on the epidemiological characteristics including gender, age, urban/ruralresidence, seasonal incidence, comorbid diseases, and preceding events， clinicalmanifestations including initial symptoms, intervals between symptom onset andhospitalization, Medical Research Council (MRC) score on admission, sensory deficits,hyporeflexia/areflexia, cranial nerve involvement and autonomic dysfunction, resultsof laboratory examination including electrophysiological abnormalities, liver enzymesincreases and cerebrospinal fluid albumincytological dissociation, and specifictreatments including intravenous immunoglobulin, plasmapheresis, and steroids. All variables were compared in patients with respiratory failure and those withoutrespiratory failure. We used univariate and multivariate logistic regression analyses todetermine the risk factors associated with respiratory failure.Results：Of the237patients we studied,37(16.1%) developed respiratory failure.No significant differences between patients with respiratory failure and those withoutrespiratory failure in gender, seasonal distribution, comorbid diseases, precedinginfection, initial symptoms, sensory deficits and hyporeflexia/areflexia, intervalsbetween symptom onset, electrophysiological classification, liver enzymes increasesand cerebrospinal fluid albumincytological dissociation by univariate analysis (P﹥0.05,respectively). Nevertheless, age distribution, urban/rural residence, MRC scores athospital admission, facial palsy, bulbar palsy, and autonomic dysfunction weresignificantly different between the two groups (P＜0.05, respectively). Multivariateanalyses identified five risk factors of respiratory failure: MRC score≤30(odds ratio,11.044), autonomic dysfunction (odds ratio,7.658), rural residents (odds ratio,3.849),facial palsy (odds ratio,3.230), and bulbar palsy (odds ratio,2.832).Conclusions: In this study respiratory failure occurred in15.6%of GBS patients.Low MRC score, autonomic dysfunction, rural residents, facial palsy and bulbar palsymay be the risk factors predicting development of respiratory failure in GBS patients.Further study is required to validate the findings of this study.