Predictors of Prolonged Duration of Mechanical Ventilation and Mortality in Patients with Guillian-Barre Syndrome

Abstract

Background: Nearly one-third of the patients with Guillian-Barre syndrome (GBS) require ventilatory assistance, the duration of which is variable. There are no studies from India to predict the duration of ventilatory requirement in patients with GBS which might help direct the clinician to perform a tracheostomy.

Aim: To study the predictors that determine the duration of mechanical ventilation (MV) and the outcome of GBS patients requiring MV. Materials and Methods: This is a retrospective, observational study from a referral teaching hospital. All consecutive patients diagnosed with GBS and requiring mechanical ventilation between 2009-2018 were included in the study. The demographic, clinical parameters, electrophysiological data, complications and outcome of these patients was noted. Factors predicting prolonged MV (>2 weeks) were statistically assessed.

Result: Out of 79 patients requiring MV, 45(57%) patients needed prolonged MV and tracheostomy was performed in 29(37%). On multivariate regression analysis, sepsis (p=0.02; {95%CI 1.3-24.4}), MRC sum score (p=0.01; {95% CI 0.89-0.99}) and lower albumin levels on day 14(p=0.004{95% CI 0.05-0.57}) correlated with prolonged duration of MV. On univariate analysis, axonal variant of GBS(p=0.02), presence of chronic renal disease(p=0.03) and pulmonary disease(p=0.01) were associated with significant mortality. On multivariate regression analysis, age (>60 years) (p=0.001) {95% CI 0.89-0.97}, prolonged duration of MV(p=0.02) {95%CI 0.88-0.99}, MRC sum score(p=0.01) {95% CI 1.01-1.1} correlated with poor outcome.

Conclusions: Sepsis and septic shock and not the choice of immunotherapy nor the electrophysiological subtypes of GBS determined the prolonged duration of MV in our cohort, though the axonal variant on electrophysiology predicted the mortality.