A Study Of The Severity And Prognosis Of Guillain-Barré Syndrome

Objective:To study the peripheral blood inflammatory indicators and their role in disease severity and short-term prognosis in patients with Guillain-Barré syndrome(GBS),and to study the clinical predictors of respiratory insufficiency in GBS.Methods:A retrospective analysis of 432 patients with Guillain-Barré syndrome who visited the First Hospital of Jilin University between 2012 and 2022 collected clinical data,including: sex,age,prodromal infection,clinical symptoms,admission m EGOS score and other general clinical data,as well as peripheral blood neutrophils(NEU),lymphocytes(LYM),platelets(PLT),Monocyte(MON)and other data,based on PLR=PLT/LYM,MLR=MON/LYM,SII=NEU*PLT/LYM,SIRI=NEU*MON/LYM were calculated PLR,MLR,SII,SIRI.According to according to whether mechanical ventilation(MV)was performed after admission,patients were divided into mechanical ventilation group(MV)and non-mechanical ventilation group(Non-MV),the peak Hughes score,the patients were divided into milder disease group(Hughes<3)and more reconstituted disease(Hughes≥3),and patients were divided into better prognosis group(Hughes<3)and poor prognosis group(Hughes≥3)according to discharge Hughes score for statistical analysis.Results:1.A total of 432 GBS patients were included in this study,247(57.2%)were male patients,185 cases(42.8%)were female patients,the average age was 49.7 years,the median age was 51 years,the most patients came to the hospital in autumn,146cases(33.8%)of upper respiratory tract infections before the onset of onset,74 cases(17.1%)of diarrhea,and 42.36% reached a peak within one week of onset;The median length of hospital stay was 14 days.There were 393 cases(90.97%)of limb weakness,221 cases(51.16%)of sensory disorders,157 cases(36.34%)of cranial nerve involvement,39 cases(9.03%)of autonomic nerve damage,72 cases(16.67%)of pain symptoms,and 387 cases(89.58%)of decreased or absent tendon reflexes.Protein-cell separation was evident in 286 patients(77.72%),and serum ganglioside antibody positive in 54 patients(54/106).There were 214 cases(61%)of electrophysiological demyelinating damage,63 cases(14%)of axonal damage,and 47cases(14%)of myelin and axonal injury.2.There were 199 cases in the group with good prognosis and 233 cases in the group with poor prognosis.There were statistically significant differences in age,length of hospital stay,mechanical ventilation,decreased or absent tendon reflexes,neuroelectrophysiology,lumbar puncture protein-cell isolation,treatment,and m EGOS scores on admission(all P<0.01).The MLR,PLR,SII,SII levels in the better prognostic group were lower than those in the better prognostic group(all P<0.01).There were no significant differences in sex ratio,time from onset to admission,peak time,presence or absence of prodromal infection events,cranial nerve involvement,sensory impairment,autonomic symptoms and pain symptoms between the two groups.3.The MLR,PLR,SII,SII and admission m EGOS scores were included in the multivariate regression analysis,and the PLR and admission m EGOS scores were independent predictors of GBS short-term prognosis,and the admission m EGOS score was the best cross-sectional value when the admission m EGOS score was 2.5points,and the AUC was 0.789(95% CI: 0.746～0.831,P<0.05),and the corresponding sensitivity and specificity were 83.3% and 60.3%,respectively.PLR was the best cross-sectional value at 133.8,AUC was 0.595(95% CI: 0.542～0.648,P<0.05),and the corresponding sensitivity and specificity were 58.4% and 61.3%,respectively.The AUC of the short-term prognosis of patients with GBS predicted by admission m EGOS score combined with PLR was 0.795(95% CI: 0.753～0.837,P<0.05),and the corresponding sensitivity and specificity were 64.8% and 82.9%,respectively.MLR,PLR,SII,SII were positively correlated with GBS disease severity and short-term prognosis,and the admission m EGOS score was an independent predictor of GBS disease severity,with the best cross-sectional value of2.5 points,AUC of 0.896(95% CI: 0.867～0.926,P<0.05),corresponding sensitivity and specificity of 78.8% and 87.3%,respectively.4.Patients were divided into mechanical ventilation group(MV)and non-mechanical ventilation group(Non-MV)according to whether or not mechanical ventilation was performed,including 70 cases in the mechanical ventilation group and362 cases in the non-mechanical ventilation group,and there were no significant differences between the two groups in terms of gender,age,sensory impairment of prodromal infection,autonomic nerve involvement(all P>0.05),but the time from onset to admission,peak time,cranial nerve involvement,MLR,PLR,SIRI,The difference between SII and admission m EGOS scores between the two groups was statistically significant(all P<0.05).Further inclusion of influencing factors in binary logistic regression analysis showed that cranial nerve involvement and admission m EGOS scores were independent risk factors for mechanical ventilation in GBS patients(P<0.05),when the m EGOS score was 5.5,the optimal transverse value was the AUC of 0.825(95% CI: 0.781～0.87,P<0.05),and the corresponding sensitivity and specificity were 74.3% and 79.2%;The AUC of mechanical ventilation in patients with GBS predicted by admission m EGOS score combined with cranial nerve involvement was 0.849(95% CI: 0.805～0.892,P<0.05),and the corresponding sensitivity and specificity were 90.0% and 70.8%,respectively.Conclusions:1.MLR,PLR,SIRI,SII are positively correlated with the short-term prognosis and disease severity of GBS patients.2.PLR>133.8 and admission m EGOS score >2.5 were independent predictors of poor prognosis in GBS patients,admission m EGOS score >2.5 were independent predictors of disease severity in GBS patients,and cranial nerve involvement and admission m EGOS score >5.5 had independent predictive value for mechanical ventilation in GBS patients.