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CSF protein biomarkers for proximal axonal damage improve prognostic accuracy in the acute phase of Guillain‐Barré syndrome
Author(s) -
Petzold A.,
Brettschneider J.,
Jin K.,
Keir G.,
Murray N.M.F.,
Hirsch N.P.,
Itoyama Y.,
Reilly M.M.,
Takeda A.,
Tumani H.
Publication year - 2009
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.21239
Subject(s) - medicine , guillain barre syndrome , cerebrospinal fluid , glial fibrillary acidic protein , headaches , odds ratio , myelin basic protein , gastroenterology , polyradiculoneuropathy , lumbar puncture , biomarker , acute motor axonal neuropathy , surgery , immunology , myelin , central nervous system , immunohistochemistry , biochemistry , chemistry
Early predictors of prognosis in Guillain‐Barré syndrome (GBS) are needed to identify patients who are likely to make a poor recovery and to guide therapeutic decision‐making in the acute phase. Here we investigate whether axonal protein biomarkers released into the cerebrospinal fluid (CSF) following proximal axonal damage improve the early prognostic accuracy in GBS. A prospective multicenter study including 132 patients (38 GBS, 38 neurological controls, 42 headaches, 14 chronic inflammatory demyelinating neuropathy). CSF levels of axonal [neurofilament (NfH) and tau] and glial (S100B and glial fibrillary acidic protein) protein biomarkers were measured on admission. Nerve conduction studies were performed at the time of lumbar puncture and patients were classified according to neurophysiological criteria. Outcome was assessed on the Hughes functional score (F‐score). Poor outcome was defined as the inability to walk independently (F‐score ≥3). High NfH levels (>0.73 ng/ml) predicted poor outcome ( P = 0.01) with an odds ratio of 7.3 and correlated with the outcome F‐score ( R = 0.51, P < 0.01), as did hTau levels ( R = 0.47, P < 0.01). Patients with poor outcome had significantly higher CSF NfH (median 1.78 ng/ml) when compared to those with good outcome (0.03 ng/ml) or all of the control groups (neurological controls 0.18 ng/ml, headaches 0.06 ng/ml, chronic inflammatory demyelinating neuropathy 0.05 ng/ml). Except for age ( P < 0.05) and need for ventilatory support ( P < 0.05), none of the other features reliably predicted outcome. Improved prognostic accuracy in the acute phase of GBS seems possible using CSF NfH levels. Muscle Nerve 40: 42–49, 2009