GUİLLAİN-BARRÉ SENDROMUNDA AĞIR ÖZÜRLÜLÜĞÜN ERKEN BELİRTEÇLERİ

Year 2022, , 643 - 649, 27.12.2022

Ümit Görgülü , Burak Geçer , Şule Bilen , Giray Kolcu

https://doi.org/10.17343/sdutfd.1188650

Abstract

Amaç
Guillain-Barré sendromu (GBS), ihmal edilemez morbidite
ve mortaliteye sahip otoimmün nörolojik bir hastalıktır.
Bu çalışma, GBS hastalarında ağır engelliliğin
erken belirteçleri olarak farklı hasta özelliklerini ve laboratuvar
bulgularını değerlendirmeyi amaçladı.
Gereç ve Yöntem
1 Ocak 2018 ile 31 Aralık 2021 tarihleri arasında GBS
tanısı alan 121 hastanın tıbbi kayıtlarını retrospektif
olarak inceledik. Demografik özellikler, başvuru şikayetleri,
ek hastalıklar, geçirilmiş enfeksiyon öyküsü,
nörolojik muayene bulguları, 1. gün ve 1. ay sonu
GBS Disabilite Skorları (GDS), serolojik ve beyin
omurilik sıvısı (BOS) incelemesi laboratuvar parametreleri,
elektromiyonörografi sonuçları, GBS alt tipleri,
tedaviler, tedaviye bağlı komplikasyonlar ve prognozlar
kaydedildi.
Bulgular
121 hastanın ortanca yaşı 58’di (20-87) (n = 73 erkek,
%60). Ortalama GDS başvuruda 3 ve birinci ayın sonunda
2 idi. Serum C-reaktif protein (CRP) ve BOS
protein seviyeleri yüksek, D vitamini seviyeleri düşüktü.
İleri yaş, kraniyal sinir tutulumu, enfeksiyon öyküsü,
yoğun bakım ünitesine (YBÜ) yatış, mekanik ventilasyon
(MV) ihtiyacı, komplikasyon varlığı, yüksek
plazma CRP düzeyleri, nötrofil-lenfosit oranı (NLR)
ve trombosit-lenfosit oranı (PLO) GBS hastalarında
1. gün ve 1. ayın sonunda ciddi engellilik ile anlamlı
şekilde ilişkiliydi.
Sonuç
GBS hastalarında ciddi engelliliği tahmin edebilecek
çok sayıda özellik belirledik.

Keywords

Biyobelirteçler, Guillain-Barré disabilite skoru, Guillain-Barré sendromu, Hughes skoru, Özürlülük belirteçleri, Biomarkers, Guillain–Barré disability score, Guillain–Barré syndrome, Hughes score, Predictors of disability

Supporting Institution

YOK

Project Number

YOK

EARLY PREDICTORS OF SEVERE DISABILITY IN GUILLAIN–BARRÉ SYNDROME

Abstract

Objective
Guillain-Barré syndrome (GBS) is an autoimmune
neurological disorder with non-negligible morbidity
and mortality. This study aimed to evaluate different
patient characteristics and laboratory findings as early
predictors of severe disability in GBS patients.
Material and Method
We retrospectively reviewed the medical records of
121 patients diagnosed with GBS between January
1, 2018, and December 31, 2021. Data regarding
demographic characteristics, presenting complaints,
co-morbidities, previous infection history, neurological
examination findings, GBS Disability Scores (GDS)
on the 1st day and by the end of the first month,
laboratory parameters of serological and cerebrospinal
fluid (CSF) examination, electromyoneurography
results, GBS subtypes, treatments, treatment-related
complications, and prognoses were recorded.
Results
The median age of the 121 patients was 58 (20–87)
years (n = 73 males, 60%). The average GDS was
3 on admission and 2 at the end of the first month.
The serum C-reactive protein (CRP) and CSF protein
levels were raised, while vitamin D levels were
reduced. Advanced age, cranial nerve involvement,
history of infection, admission to the intensive care
unit (ICU), need for mechanical ventilation (MV),
presence of complications, high plasma CRP levels,
neutrophil-lymphocyte ratio (NLR), and plateletlymphocyte
ratio (PLO) were significantly associated
with severe disability in GBS patients at day 1 and at
the end of the first month.
Conclusion
We identified multiple characteristics that can predict
severe disability in GBS patients.

Keywords

Biomarkers, Guillain–Barré disability score, Guillain–Barré syndrome, Hughes score, Predictors of disability

Project Number

YOK

References

• 1. Nobuhiro Y, Hartung HP. "Guillain–barré syndrome." New England Journal of Medicine 2012;366.24:2294-2304.
• 2. McGrogan A, Madle GC, Seaman HE, De Vries CS. The epidemiology of Guillain-Barré syndrome worldwide. Neuroepidemiology 2009;32(2):150-163.
• 3. Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology 2011;36(2):123-133.
• 4. Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. The Lancet, 2021;397(10280):1214-1228.
• 5. Hao Y, Wang W, Jacobs BC, Qiao B, Chen M, Liu D, et al. Antecedent infections in Guillain‐Barré syndrome: a single‐center, prospective study. Annals of clinical and translational neurology 2019;6(12):2510-2517.
• 6. Willison HJ, Yuki N. Peripheral neuropathies and anti‐glycolipid antibodies. Brain 2022;125(12):2591-2625.
• 7. Hafer‐Macko CE, Sheikh KA, Li CY, Ho TW, Cornblath DR, McKhann GM, et al. Immune attack on the Schwann cell surface in acute inflammatory demyelinating polyneuropathy. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society 2019;39(5):625-635.
• 8. Malek E, Salameh J. Guillain–Barre Syndrome. In Seminars in neurology 2019;39:589-595.
• 9. Shahrizaila N, Yuki N. Bickerstaff brainstem encephalitis and Fisher syndrome: anti-GQ1b antibody syndrome. Journal of Neurology, Neurosurgery & Psychiatry 2013;84(5): 576-583.
• 10. Rajabally YA, Durand MC, Mitchell J, Orlikowski D, Nicolas G. Electrophysiological diagnosis of Guillain–Barré syndrome subtype: could a single study suffice? Journal of Neurology, Neurosurgery & Psychiatry 2015;86(1):115-119.
• 11. Restrepo-Jiménez P, Rodríguez Y, González P, et al. The immunotherapy of Guillain-Barré syndrome. Expert Opin Biol Ther 2018;18(6):619-631. doi: 10.1080/14712598.2018. 1468885.
• 12. Rajabally YA, Uncini A. Outcome and its predictors in Guillain– Barré syndrome. Journal of Neurology, Neurosurgery & Psychiatry 2012;83(7):711-718.
• 13. Walgaard C, Lingsma HF, Ruts L, Van Doorn PA, Steyerberg EW, Jacobs BC. Early recognition of poor prognosis in Guillain- Barre syndrome. Neurology 2011;76(11):968-975
• 14. Verma R, Chaudhari TS, Raut TP, Garg RK. Clinico-electrophysiological profile and predictors of functional outcome in Guillain–Barre syndrome (GBS). Journal of the neurological sciences 2013;335(1-2):105-111.
• 15. Tunç A. Early predictors of functional disability in Guillain–Barré Syndrome. Acta Neurologica Belgica 2019;119(4):555-559.
• 16. Su Z, Chen Z, Xiang Y, Wang B, Huang Y, Yang D, et al. Low serum levels of uric acid and albumin in patients with Guillain– Barre syndrome. Medicine 2017;96(15):e6618.
• 17. Wen P, Wang L, Liu H, Gong L, Ji H, Wu H, et al. Risk factors for the severity of Guillain-Barré syndrome and predictors of shortterm prognosis of severe Guillain-Barré syndrome. Scientific Reports 2021;11(1):1-9.
• 18. Li X, Li W, Shi X, Mo L, Luo Y, Qin L, et al. Is serum bilirubin associated with the severity of Guillain–Barré syndrome?. International Journal of Neuroscience 2018;128(7): 595-599.
• 19. Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Increased cerebrospinal fluid protein and motor conduction studies as prognostic markers of outcome and nerve ultrasound changes in Guillain–Barré syndrome. Journal of the neurological sciences 2014;340(1-2):37-43.
• 20. Jacobs BC, Van Den Berg B, Verboon C, Chavada G, Cornblath DR, Gorson KC, et al. International Guillain‐Barré Syndrome Outcome Study: protocol of a prospective observational cohort study on clinical and biological predictors of disease course and outcome in Guillain‐Barré syndrome. Journal of the Peripheral Nervous System 2017;22(2):68-76.
• 21. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain‐Barré syndrome. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society 1990;27(S1):S21-S24.
• 22. Hughes RAC, Newsom-Davis JM, Perkin GD, Pierce, JM. Controlled trial of prednisolone in acute polyneuropathy. The Lancet 1978;312(8093):750-753.
• 23. Van Koningsveld R, Steyerberg EW, Hughes RA, Swan AV, van Doorn PA, Jacobs BC. A clinical prognostic scoring system for Guillain-Barré syndrome. The Lancet Neurology 2007;6(7):589- 594.
• 24. Doets AY, Verboon C, Van Den Berg B, Harbo T, Cornblath DR, Willison HJ, et al. Regional variation of Guillain-Barré syndrome. Brain 2018;141(10):2866-2877.
• 25. Hadden RDM, Karch H, Hartung HP, Zielasek J, Weissbrich B, Schubert J, et al. Preceding infections, immune factors, and outcome in Guillain–Barré syndrome. Neurology 2001;56(6):758-765.
• 26. Chiò A, Cocito D, Leone M, Giordana MT, Mora G, Mutani R. Guillain-Barré syndrome: a prospective, population-based incidence and outcome survey. Neurology 2003;60(7):1146-1150.
• 27. Wakerley BR, Yuki N. Infectious and noninfectious triggers in Guillain–Barré syndrome. Expert review of clinical immunology 2013;9(7):627-639.
• 28. Dalakas MC. Guillain-Barré syndrome: The first documented COVID-19–triggered autoimmune neurologic disease: More to come with myositis in the offing. Neurology-Neuroimmunology Neuroinflammation 2020;7(5):e781.
• 29. Parra B, Lizarazo J, Jiménez-Arango JA, Zea-Vera AF, González- Manrique G, Vargas J, et al. Guillain–Barré syndrome associated with Zika virus infection in Colombia. New England Journal of Medicine 2016;375(16):1513-1523.
• 30. Chang SH, Tian XB, Wang J, Liu MQ, Huang CN, Qi Y, et al. Increased Cerebrospinal Fluid Uric Acid Levels in Guillain–Barré Syndrome. Frontiers in Neurology 2020; 11:589928.
• 31. Arami MA, Yazdchi M, Khandaghi R. Epidemiology and characteristics of Guillain-Barré syndrome in the northwest of Iran. Annals of Saudi medicine 2006;26(1):22-27.
• 32. Hughes RA, Cornblath DR. Guillain-barre syndrome. The Lancet 2005;366(9497): 1653-1666.
• 33. Fourrier F, Robriquet L, Hurtevent JF, Spagnolo S. A simple functional marker to predict the need for prolonged mechanical ventilation in patients with Guillain-Barré syndrome. Critical Care 2011;15(1):1-7.
• 34. Flachenecker P, Wermuth P, Hartung HP, Reiners K. Quantitative assessment of cardiovascular autonomic function in Guillain‐ Barré syndrome. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society 1997;42(2):171-179.
• 35. Esposito S, Longo MR. Guillain–barré syndrome. Autoimmunity reviews 2017;16(1):96-101.
• 36. Li X, Li W, Shi X, Mo L, Luo Y, Qin L, et al. Is serum bilirubin associated with the severity of Guillain–Barré syndrome?. International Journal of Neuroscience 2018;128(7): 595-599.
• 37. Ozdemir HH. Analysis of the albumin level, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio in Guillain-Barré syndrome. Arquivos de neuro-psiquiatria 2016;74:718-722.
• 38. Vaishnavi C, Kapoor P, Behura C, Singh SK, Prabhakar SC-reactive protein in patients with Guillain Barré syndrome. Indian Journal of Pathology and Microbiology 2014;57(1):51.
• 39. Akıl E, Bulut A, Kaplan İ, Özdemir HH, Arslan D, Aluçlu MU. The increase of carcinoembryonic antigen (CEA), high-sensitivity C-reactive protein, and neutrophil/lymphocyte ratio in Parkinson’s disease. Neurological Science 2015;36(3):423-428.
• 40. Aras YG, Gungen, BD, Kotan D. Neutrophil/Lymphocyte ratio in migraine patients and ıts correlation with aura. Ajans 2015;3(4):162-6.
• 41. Koseoglu HI, Altunkas F, Kanbay A, Doruk S, Etikan I, Demir O. Platelet–lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome. Journal of thrombosis and thrombolysis 2015;39(2):179-185.
• 42. Alan S, Tuna S, Türkoğlu EB. The relation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume with the presence and severity of Behcet's syndrome. The Kaohsiung journal of medical sciences 2015;31(12):626-631.
• 43. Akıl E, Akıl MA, Varol S, Özdemir HH, Yücel Y, Arslan D, et al. Echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio are novel inflammatory predictors of cerebral ischemic stroke. Journal of Stroke and Cerebrovascular Diseases 2014;23(9):2328-2334.
• 44. Demirci S, Demirci S, Kutluhan S, Koyuncuoglu HR, Yurekli VA. The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis. International Journal of Neuroscience 2019;126(8):700-706.
• 45. Berciano J, Figols J, García A, Calle E, Illa I, Lafarga M, et al. Fulminant Guillain–Barré syndrome with universal inexcitability of peripheral nerves: a clinicopathological study. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine 1997;20(7):846-857.
• 46. Bedel C, Korkut M. The Clinical Significance of Neutrophil Lymphocyte ratio, Monocyte Lymphocyte ratio and Platelet Lymphocyte ratio in Patients with Guillain-Barré Syndrome. The Medical Journal Of Haydarpaşa Numune Training and Research Hospital 2021;61(3):341-345