The Analysis Of Related Factors For Severity Of Guillain Barre Syndrome During Acute Phase

Objective: To analysis the clinical,electrophysiological,cerebrospinal fluid’s characterastics of Guillain–Barré syndrome(GBS), determine the approximate frequencyof severe GBS without the ability to waik. Explore if there were features that predicted that the illness would remain severe.Study patients with the mild form of Guillain–Barrésyndrome can further contribute to knowledge of the spectrum of the syndrome and explore whether this subgroup may need treatment with IV immunoglobulin.Methods: Patientsfulfillingthe US National Institute of Neurological Disorders and Stroke modified criteria for Guillain–Barrésyndrome were included in a survey from 2000 to 2014in Chang Hai Hospital. Clinical characteristics,electrophysiologicalcharacteristics and cerebrospinal fluid’s data were collected retrospectively. GBS disability scale was used to evaluate the clinical status of patients in acute stage.Clinical,cerebrospinal fluid,electrophysiological characterastics of GBS were analyzed in multivariable logistic model in order to find out the related factors of the severe GBS.Results: A total of 113 patients were included. 24 of the patients(21%) included were mildly affected, and 89(79%) were severely affected. Amongthese 2(1.8%) patients died during in-hospital stay. 72(67.3%) were male and 41(36.3%)were female,with a mean onset age of 48.41± 15.4 years(range12–79).The most frequent infectionwas respiratory infection, reported in 54 patients(47.8%). Other infections were gastrointestinal in35(31%),there was nosignificant difference in the seasonal distribution(P =0.239).Autonomicdysfunction in 71(65.5%).Cranial nerve involvement in50(44.2%).Electrophysiological examination was performed in 61 cases, 22 cases(36.1%) wereof axonal variety and 39(13.9%) of demyelinating variety. Most patientsunderwent only one lumbar puncture.The severe GBS group showed higher immunoglobulin Ig G levels When compared to the mild group,resulting in statistical significant differences( P=0.004) On univariate analysis, predictors associatedwith poorfunctional outcome during acute phase were diarrhea(P=0.027),age≥50 years(P<0.001),cardiovascular symptoms(P=0.03),choking sensation in chest(P=0.003), increase of CSF immunoglobulin G(P=0.004).On multivariate analysis, age≥50 years(P=0.034,OR=14.702,95%CI:1.228-175.982), increase of immunoglobulin G in CSF(P=0.028,OR=26.652,95%CI:1.438-493.791),neuraxon impairment(P=0.037,OR=48.529,95%CI:1.273-1850.656) were independently associated with severe GBS.From pure Clinicalcharacteristics,Diarrhea(P=0.003, OR=13.072, 95%CI : 2.437-70.124), age≥50years(P=0.000, OR=30.866, 95%CI:6.825-139.585) were independently associated with early recognition of severe GBS.Conclusion: patients withage≥50 years and diarrhea should be pay attention to at onset,because they may develop to severe GBS.age≥50 years, increase of immunoglobulin G in CSF,neuraxon impairment may be independent risk factor of severe GBS.personalized treatment should be granted for such patients in advance. The geographical diversity is probably attributable to differences in exposure to certain types of infection, possibly in combination with different genetic susceptibilities due to varying genetic polymorphisms between individuals or groups of people living in different areas of the world.These differences may be related not only to the development of a specific GBS subtype, but also to the course and severity of GBS. Genetic studies with a high number of patients are required to investigate these relationships.