Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(08): 697-704
DOI: 10.1590/0004-282X-anp-2020-0154
Article

Clinical-epidemiological characteristics associated with discharge outcomes and seasonality among surviving patients with Guillain-Barré syndrome in a national third-level hospital, Lima, Peru

Características clínico-epidemiológicas asociadas con los resultados al alta y la estacionalidad entre los pacientes sobrevivientes con síndrome de Guillain-Barré en un hospital nacional de tercer nivel, Lima, Peru
Victor Velásquez-Rimachi 
1   Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.
2   Red de Eficacia Clínica y Sanitaria, Lima, Peru.
3   Universidad Científica del Sur, Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Lima, Peru.
,
Angélica Verónica López-Saavedra 
1   Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.
2   Red de Eficacia Clínica y Sanitaria, Lima, Peru.
4   Universidad Nacional Mayor de San Marcos, Sociedad Científica de San Fernando, Lima, Peru.
,
Ethel Rodriguez-López 
1   Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.
2   Red de Eficacia Clínica y Sanitaria, Lima, Peru.
4   Universidad Nacional Mayor de San Marcos, Sociedad Científica de San Fernando, Lima, Peru.
,
Hillary Elguera-Huaman 
1   Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.
4   Universidad Nacional Mayor de San Marcos, Sociedad Científica de San Fernando, Lima, Peru.
,
Kelly Meza 
5   Weill Cornell Medicine, Department of Pediatrics, Division of Pediatric Nephrology, New York NY, USA
,
Carlos Alva-Díaz 
3   Universidad Científica del Sur, Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Lima, Peru.
6   Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Peru.
,
Kevin Pacheco-Barrios 
7   Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
8   SYNAPSIS Mental Health and Neurology Non-Profit Organization, Lima, Peru.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Background: Guillain-Barré syndrome (GBS) is an autoimmune disease that affects the peripheral nervous system. Severe motor deficit (SMD), respiratory impairment, cranial nerve involvement and autonomic dysfunction are associated with a poor prognosis. Objective: To investigate the association between the clinical-epidemiological characteristics and the discharge results among Peruvian patients with GBS. Methods: We carried out a retrospective observational study on patients with GBS who survived until discharge. We used the Brighton Collaboration’s criteria and considered Hughes Severity Scale (HSS) scores greater than two to be SMD. We defined the discharge results as an improvement if the HSS score decreased by at least one point from admission to hospital discharge and defined hospital stay as prolonged if > 14 days. Results: We analyzed 92 patients, among whom 70.7% were male. Quadriparesis (81.1%) and hyporeflexia (86.8%) were the most characteristic manifestations. We observed that more than half of the cases were in summer and winter. Gastrointestinal infections were associated with a higher proportion of prolonged stays. The proportion of improvement was lower among patients who had an SMD at hospital admission. We confirmed these results through fitting in multivariate models. Conclusions: The prolonged stay was related to previous gastrointestinal infection, while a less improvement in SMD individuals at admission. Prospective multicenter surveillance systems are needed for monitoring GBS cases in low-income settings like Peru.

RESUMEN

Antecedentes: El síndrome de Guillain-Barré (SGB) es una enfermedad autoinmune que afecta al sistema nervioso periférico. Déficit motor severo (DMS), compromiso respiratorio, afectación de pares craneales y disfunción autonómica se asocian con un mal pronóstico. Objetivo: Investigar la asociación entre las características clínico-epidemiológicas y los resultados del alta en pacientes peruanos con SGB. Métodos: Realizamos un estudio observacional retrospectivo de pacientes con SGB supervivientes hasta el alta. Consideramos los criterios de colaboración de Brighton y una escala de severidad de Hughes (ESH) superior a dos como un DMS. Definimos los resultados del alta como una mejoría si el ESH disminuyó en al menos un punto desde el ingreso hasta el alta hospitalaria y una estadía prolongada si el tiempo de hospitalización fue > 14 días. Resultados: Analizamos 92 pacientes, de los cuales el 70,7% eran varones. La cuadriparesia (81,1%) y la hiporreflexia (86,8%) fueron las manifestaciones más características. Observamos más de la mitad de los casos en verano e invierno. Las infecciones gastrointestinales se asociaron con una mayor proporción de estadías prolongadas. La proporción de mejoría fue menor en los pacientes que tenían un DMS al ingreso hospitalario. Confirmamos estos resultados con modelos multivariados ajustados. Conclusiones: La estadía prolongada se relacionó con infección gastrointestinal previa, mientras que una mejoría menor en individuos con DMS al ingreso. Necesitamos sistemas de vigilancia multicéntricos prospectivos para monitorear los casos de SGB en un entorno de bajos ingresos como Perú.

Keywords:

Guillain-Barré Syndrome - Seasons - Peripheral Nervous System

Palabras clave:

Síndrome de Guillain-Barré - Estaciones del Año - Sistema Nervioso Periférico

Authors’ contribution:

VVR: conceived and designed the analysis; ALS, ERL, HEH: collected the data; VVR, KPB: performed the analysis; VVR, ALS, ERL, HEH, KM: wrote the paper; CAD, KPB: gave expert advice. All authors approved the final version for publishing.




Publication History

Received: 11 April 2020

Accepted: 13 November 2020

Article published online:
01 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • REFERENCES

  • 1 Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27(Suppl):S21-4. https://doi.org/10.1002/ana.410270707
  • 2 van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014 Aug;10(8):469-82. https://doi.org/10.1038/nrneurol.2014.121
  • 3 Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016 Aug 13;388(10045):717-27. https://doi.org/10.1016/S0140-6736(16)00339-1
  • 4 Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain. 2014 Jan;137(Pt 1):33-43. https://doi.org/10.1093/brain/awt285
  • 5 Shrivastava M, Nehal S, Seema N. Guillain-Barre syndrome: Demographics, clinical profile & seasonal variation in a tertiary care centre of central India. Indian J Med Res. 2017 Feb;145(2):203-8. https://doi.org/10.4103/ijmr.ijmr_995_14
  • 6 Rivera-Lillo G, Torres-Castro R, Burgos PI, Varas-Díaz G, Vera-Uribe R, Puppo H, Hernández M. Incidence of Guillain-Barré syndrome in Chile: a population-based study. J Peripher Nerv Syst. 2016 Dec;21(4):339-44. https://doi.org/10.1111/jns.12182.
  • 7 Munayco CV, Soto Cabezas MG, Reyes MF, Arica Gutiérrez JA, Napanga Saldaña O. Epidemiología del síndrome de guillain-barré en el Perú. Rev Peru Med Exp Salud Publica. 2019 Jan-Mar;36(1):10-6. https://doi.org/10.17843/rpmesp.2019.361.3729
  • 8 Ballón-Manrique B, Campos-Ramos N. Características clínicas y paraclínicas del Síndrome de Guillain-Barré en el Hospital Regional Lambayeque. Rev Neuropsiquiatr. 2017;80(1):22-6. https://doi.org/10.20453/rnp.v80i1.3056
  • 9 Costa ACD. Síndrome de Guillain-Barré: uma revisão integrativa de literatura e de dados do sistema único de saúde [dissertation]. Brasília, BR: UnB; 2016.
  • 10 Organización Panamericana de la Salud. Recomendaciones prácticas para la implementación de las guías de detección y atención del síndrome de Guillain-Barré relacionado con Zika en la Región de las Américas. 2016. Washington: OPS.
  • 11 Walgaard C, Lingsma HF, Ruts L, Drenthen J, van Koningsveld R, Garssen MJ, et al. Prediction of respiratory insufficiency in Guillain-Barré syndrome. Ann Neurol. 2010 Jun;67(6):781-7. https://doi.org/10.1002/ana.21976
  • 12 González-Suárez I, Sanz-Gallego I, Rodríguez de Rivera FJ, Arpa J. Guillain-Barré syndrome: natural history and prognostic factors: a retrospective review of 106 cases. BMC Neurol. 2013 Jul 22;13:95. https://doi.org/10.1186/1471-2377-13-95
  • 13 Bae JS, Kim YJ, Kim JK. Diabetes mellitus exacerbates the clinical and electrophysiological features of Guillain-Barré syndrome. Eur J Neurol. 2016 Mar;23(3):439-46. https://doi.org/10.1111/ene.12885
  • 14 Kuwabara S, Ogawara K, Misawa S, Koga M, Mori M, Hiraga A, et al. Does Campylobacter jejuni infection elicit "demyelinating" Guillain-Barre syndrome? Neurology. 2004 Aug 10;63(3):529-33. https://doi.org/10.1212/01.wnl.0000133205.05169.04
  • 15 Zhang Y, Zhao Y, Wang Y. Prognostic factors of Guillain-Barré syndrome: a 111-case retrospective review. Chin Neurosurg J. 2018 Jun 18;4:14. https://doi.org/10.1186/s41016-018-0122-y
  • 16 World Health Organization [Internet]. Guillain-Barré syndrome - updated 2016 October 31. [cited 2021 August 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/guillain-barré-syndrom
  • 17 Martinez JC, Misnaza SP. Mortalidad por enfermedades huérfanas en Colombia, 2008-2013. Biomedica. 2018;38(2):198-200. https://doi.org/10.7705/biomedica.v38i0.3876
  • 18 Díaz-Soto S, Chavez K, Chaca A, Alanya J, Tirado-Hurtado I. Outbreak of Guillain-Barre syndrome in Peru. eNeurologicalSci. 2019 Feb 7;14:89-90. https://doi.org/10.1016/j.ensci.2019.02.001
  • 19 Alva-Diaz C, Mori N, Pacheco-Barrios K, Velásquez-Rimachi V, Rivera-Torrejon O, Huerta-Rosario CA, et al. Guía de práctica clínica para el diagnóstico y tratamiento del paciente con síndrome de Guillain-Barré, Perú, 2018. Neurología Argentina. 2020;12(1):36-48https://doi.org/10.1016/j.neuarg.2019.09.006
  • 20 Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher. 2016 Jun;31(3):149-62. https://doi.org/10.1002/jca.21470
  • 21 Manrique GG, Bahamon GG, Motta AG, Ramos CFR. Síndrome Guillain-Barré: un mirada actual. RFS Revista Facultad de Salud. 2016;8(2):38-45. https://doi.org/10.25054/rfs.v8i2.1408
  • 22 Martic V, Bozovic I, Berisavac I, Basta I, Peric S, Babic M, et al. Three-Year Follow-Up Study in Patients with Guillain-Barré Syndrome. Can J Neurol Sci. 2018 May;45(3):269-74. https://doi.org/10.1017/cjn.2018.12
  • 23 Momen AA, Shakurnia A. The Epidemiology of Guillain-Barré Syndrome in Children under 15 Years Old in Southwest Iran. Biomed Hub. 2017 Oct 10;2(3):1-8. https://doi.org/10.1159/000480693
  • 24 Sudulagunta SR, Sodalagunta MB, Sepehrar M, Khorram H, Bangalore Raja SK, Kothandapani S, et al. Guillain-Barré syndrome: clinical profile and management. Ger Med Sci. 2015 Sep 21;13:16. https://doi.org/10.3205/000220
  • 25 Dirlikov E, Major CG, Medina NA, Lugo-Robles R, Matos D, Muñoz-Jordan JL, et al. Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus Infection, Puerto Rico, 2016. JAMA Neurol. 2018 Sep 1;75(9):1089-97. https://doi.org/10.1001/jamaneurol.2018.1058
  • 26 Peric S, Milosevic V, Berisavac I, Stojiljkovic O, Beslac-Bumbasirevic L, Marjanovic I, et al. Clinical and epidemiological features of Guillain-Barré syndrome in the Western Balkans. J Peripher Nerv Syst. 2014 Dec;19(4):317-21. https://doi.org/10.1111/jns.12096
  • 27 Netto AB, Taly AB, Kulkarni GB, Rao UG, Rao S. Mortality in mechanically ventilated patients of Guillain Barré Syndrome. Ann Indian Acad Neurol. 2011 Oct;14(4):262-6. https://doi.org/10.4103/0972-2327.91942
  • 28 Chakraborty T, Kramer CL, Wijdicks EFM, Rabinstein AA. Dysautonomia in Guillain-Barré Syndrome: Prevalence, Clinical Spectrum, and Outcomes. Neurocrit Care. 2020 Feb;32(1):113-20. https://doi.org/10.1007/s12028-019-00781-w
  • 29 Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2017 Feb 27;2(2):CD001798. https://doi.org/10.1002/14651858.CD001798.pub3
  • 30 Palma-Garcia L, Velásquez-Rimachi V, Pezo-Pezo A, Roig J, Perez-Villegas J. Therapeutic plasma exchange: Experience in a third level hospital, 2013-2016, Lima (Peru). J Clin Apher. 2018 Aug;33(4):480-5. https://doi.org/10.1002/jca.21623
  • 31 Webb AJ, Brain SA, Wood R, Rinaldi S, Turner MR. Seasonal variation in Guillain-Barré syndrome: a systematic review, meta-analysis and Oxfordshire cohort study. J Neurol Neurosurg Psychiatry. 2015 Nov;86(11):1196-201. https://doi.org/10.1136/jnnp-2014-309056
  • 32 Cheng BC, Chang WN, Chang CS, Chee CY, Huang CR, Chen JB, et al. Guillain-Barré syndrome in southern Taiwan: clinical features, prognostic factors and therapeutic outcomes. Eur J Neurol. 2003 Nov;10(6):655-62. https://doi.org/10.1046/j.1468-1331.2003.00683.x
  • 33 Chroni E, Papapetropoulos S, Gioldasis G, Ellul J, Diamadopoulos N, Papapetropoulos T. Guillain-Barré syndrome in Greece: seasonality and other clinico-epidemiological features. Eur J Neurol. 2004 Jun;11(6):383-8. https://doi.org/10.1111/j.1468-1331.2004.00799.x