Open AccessRisk factors for respiratory failure in Guillain‐Barré syndrome in Bangladesh: a prospective study
Author(s) -
Islam Zhahirul,
Papri Nowshin,
Ara Gulshan,
Ishaque Tanveen,
Alam Arafat U.,
Jahan Israt,
Islam Badrul,
Mohammad Quazi D.
Publication year - 2019
Publication title -
annals of clinical and translational neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.824
H-Index - 42
ISSN - 2328-9503
DOI - 10.1002/acn3.706
Subject(s) - medicine , interquartile range , guillain barre syndrome , dysautonomia , mechanical ventilation , odds ratio , prospective cohort study , risk factor , respiratory failure , surgery , pediatrics , disease
Abstract Objective We investigated clinical, biological, and electrophysiological risk factors for mechanical ventilation (MV) and patient outcomes in Bangladesh using one of the largest, prospective Guillain‐Barré syndrome (GBS) cohorts in developing world. Methods A total of 693 GBS patients were included in two GBS studies conducted between 2006 and 2016 in Dhaka, Bangladesh. Associations between baseline characteristics and MV were tested using Fisher's exact test, χ 2 test, or Mann–Whitney U ‐test, as appropriate. Risk factors for MV were assessed using multivariate logistic regression. Survival analysis was performed using Kaplan–Meier method; comparisons between groups performed using log‐rank test. Results Of 693 patients, 155 (23%) required MV (median age, 26 years; interquartile range [IQR] 17–40). Among the ventilated patients, males were predominant (68%) than females. The most significant risk factor for MV was bulbar involvement (adjusted odds ratio [AOR]:19.07; 95% CI = 89.00–192.57, P = 0.012). Other independently associated factors included dysautonomia (AOR:4.88; 95% CI = 1.49–15.98, P = 0.009) and severe muscle weakness at study entry (AOR:6.12; 95% CI = 0.64–58.57, P = 0.048). At 6 months after disease onset, 20% of ventilated and 52% of non‐ventilated patients ( P < 0.001) had recovered completely or with minor symptoms. Mortality rate was significantly higher among ventilated patients than non‐ventilated patients (41% vs. 7%, P < 0.001). Interpretation Bulbar involvement, dysautonomia and severe muscle weakness were identified as the most important risk factors for MV among GBS patients from Bangladesh. The findings may help to develop predictive models for MV in GBS in developing countries to identify impending respiratory failure and proper clinical management of GBS patients.