Risk Factors Of Respiratory Failure In Patients With Guillain-barré Syndrome

Objective: Guillain-Barré syndrom(GBS)is an autoimmune peripheral neuropathy.Respiratory failure is a fatal complication of GBS and is associated with prolonged hospital stay and poor prognosis.Previous studies have shown that about 20 to 30 percent of patients with GBS develop respiratory failure.Previous studies have analyzed multiple risk factors for respiratory failure in patients with GBS,including rapid progression of muscle weakness,shorter peak time of symptoms,autonomic nerve dysfunction and so on.However,the predictive value of these indicators for respiratory failure is controversial and the research results are inconsistent,so more clinical data are needed for further confirmation.The purpose of this study was to compare the clinical characteristics and laboratory tests among patients with or without respiratory failure,to determinate risk factors for respiratory failure in patients with GBS,to help clinicians identify patients who may have respiratory failure in the early stage,to transfer the patients to the intensive care unit timely and avoid the adverse consequences caused by emergency endotracheal intubation.Methods: Medical records of 120 hospitalized patients with GBS were collected.Patients with respiratory failure during hospitalization were included in the respiratory failure group and patients without respiratory failure during hospitalization were included in the non-respiratory failure group.Differences in onset season,sex,age,precursor events,initial symptoms,cerebral nerve involvement during the course of the disease,Hughes Functional Grading Scale(HFGS)score on admission,neutrophil-lymphocyte ratio(NLR),serum albumin,cerebrospinal fluid examination results were compared between the two groups.Risk factors for respiratory failure in patients with GBS were determined by retrospective analysis.Results: Among 120 patients with GBS,there were 76 males(63.33%)and 44 females(36.67%).There were 14 cases(11.67%)under 30 years old,58 cases(48.33%)between 30 and 60 years old and 48 cases(40%)over 60 years old,with an average age of(53.60 ± 17.92)years old.There were 52 cases(43.33%)with prodromal infection,41 cases(34.17%)with respiratory tract infection,3 cases(2.5%)with surgery or trauma and 3 cases(2.5%)with other prodromal events.Limb weakness was the initial symptom in 58 cases(48.33%),cranial nerve involvement was the initial symptom in 13 cases(10.83%)and paresthesia was the initial symptom in 49cases(40.84%).There were 26 patients(21.67%)in the respiratory failure group and94 patients(78.33%)in the non-respiratory failure group.There were statistically significant differences between the two groups in cerebral nerve involvement(P=0.011),HFGS score on admission(P<0.000),NLR(P<0.000)and serum albumin(P<0.000).Multivariate Logistic regression analysis further determined two risk factors related to respiratory failure: bulbar paralysis(P=0.004,OR=13.094,95%CI=2.244-76.395)and HFGS score on admission(P=0.000,OR=23.540,95%CI=4.624-119.836).Conclusion:A total of 120 patients with GBS were included in this study,of which 26cases(21.67%)developed respiratory failure during hospitalization.Bulbar paralysis and Higher scores on HFGS score on admission may be risk factors for respiratory failure in patients with GBS.