Variants, clinical characteristics and prognostic factors of Guillain Barre Syndrome in Chinese

Abstract

OBJECTIVE: To investigate the variants, clinical characteristics and prognostic factors of Guillain Barre Syndrome (GBS) in Hong Kong Chinese. BACKGROUND: The variants, clinical characteristics and prognostic factors of adults with GBS in Hong Kong has not been widely studied previously. DESIGN/METHODS: We performed a retrospective review of adults with GBS admitted to Queen Mary Hospital, Hong Kong during the period 1997-2011. RESULTS: Mean age of the patients was 57+/-17 years and the mean hospital stay was 36+/-69 days. Male:female ratio was 1.5:1. Of the 63 patients with GBS, 4.8% had acute motor axonal neuropathy, 17.5% with Miller-Fisher syndrome and 77.8% were of the acute inflammatory demyelinating polyneuropathy together with other unspecified subtypes. 49.2% had preceding upper respiratory tract illness, 4.76% preceding gastrointestinal illness, whilst 7.94% received vaccination during the 6weeks preceding onset of neurological symptoms. 22.2% patients were admitted to Intensive Care Unit and 12.7% patients required mechanical ventilation. 19.0% patients were treated conservatively, 39.7% received intravenous immunoglobulin only, 30.2% received plasmapharesis only and 11.0% received both intravenous immunoglobulin and plasmapharesis. 36.1% of patients was associated with poor functional recovery (requiring walking with aid at 6months after admission). Multivariate analysis revealed that necessity of mechanical ventilation during hospitalization (Odds Ratio = 43.3, 95% confidence interval: 1.2-1539.4, p=0.039) was an independent predictor of poor functional recovery at 6months after admission. Receiver Operating Characteristics curve also showed that an Erasmus GBS Outcome Score>4 was associated with good functional recovery with area under Receiver Operating Characteristic Curve being 0.87 (p<0.0001). CONCLUSIONS: Miller Fisher syndrome is more common in the Chinese population compared to the West. Necessity of mechanical ventilation during hospitalization is an independent predictor of poor functional recovery and the Erasmus GBS Outcome Score is a useful score in predicting functional recovery.