What are the negative prognostic factors of Guillain-Barre syndrome (GBS)?

Updated: Apr 21, 2020
  • Author: Michael T Andary, MD, MS; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

The following factors have been associated with adverse effect on outcomes in GBS [6, 92, 93] :

  • Preceding gastrointestinal infection or diarrheal illness

  • Older age (57 years or older)

  • Poor upper extremity muscle strength

  • Acute hospital stay of longer than 11 days

  • ICU requirement

  • Need for mechanical ventilation

  • Medical Research Council (MRC) score below 40

  • Discharge to rehabilitation

A rapidly progressing onset of weakness also has been associated with less favorable outcomes in many studies, although in other reports, delayed time to peak disability has been shown to be an independent predictor of poor outcome at 1 year.

Mean compound muscle action potential (CMAP) amplitudes of less than 20% of the lower limit of normal or the presence of inexcitable nerves on initial electrophysiologic studies are other predictors of poorer functional outcomes. Later tests (>1 mo after onset) showing persistence of a low mean CMAP have an even higher sensitivity and specificity than do initial tests showing low amplitude.

A prospective, multicenter study by Petzold et al suggested that CSF levels of high ̶ molecular weight neurofilament (NfH) protein, an axonal protein, are prognostic indicators in GBS. [94] The investigators found that among patients with GBS who suffered a poor outcome (defined as an inability to walk independently), the median NfH level was 1.78 ng/mL; in patients with GBS who had a good outcome, the median level was 0.03 ng/mL.

Increased CSF levels of neuron-specific enolase and S-100b protein are also associated with longer duration of illness. [8] Serologically, a longer-lasting increase in immunoglobulin M (IgM) anti-GM1 predicts slow recovery. [8]

The presence of underlying pulmonary disease or manifestation of dysautonomia has no prognostic significance in GBS.

A cohort study by van den Berg et al indicated that in patients with GBS, an association exists between prolonged mechanical ventilation (>2 months) and poor prognosis, although a cross-sectional study by these investigators suggested that some patients who have undergone prolonged mechanical ventilation may demonstrate slow, persistent recovery that eventually allows them to walk unaided and live independently. At 6 months, in the cohort study, the ability to walk unaided had been achieved in 18% of patients treated with prolonged mechanical ventilation and in 76% of those who underwent a shorter ventilation period. However, in the cross-sectional study, which had a median follow-up period of 11 years, 58% of patients who underwent prolonged mechanical ventilation could, at maximum follow-up, walk unaided, including 31% who achieved this outcome more than a year subsequent to diagnosis. [95]


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