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

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.摘要 研究背景：吉兰-巴雷综合征（Guillain-Barré syndrome, GBS）是一类累及周围神经系统的自身免疫性疾病。重度运动功能缺损（severe motor deficit, SMD）、呼吸功能受损、颅神经受累及自主神经功能紊乱均与不良预后相关。研究目的：探讨秘鲁吉兰-巴雷综合征患者的临床-流行病学特征与出院结局之间的关联。研究方法：本研究为回顾性观察性研究，纳入存活至出院的吉兰-巴雷综合征患者。采用布莱顿协作组（Brighton Collaboration）制定的诊断标准，将休斯严重程度量表（Hughes Severity Scale, HSS）评分＞2分定义为重度运动功能缺损。若从入院至出院时HSS评分较入院时至少降低1分，则将出院结局判定为病情改善；若住院时长＞14天，则判定为住院时间延长。研究结果：共纳入分析92例患者，其中70.7%为男性。最具特征性的临床表现为四肢瘫（81.1%）与反射减退（86.8%）。超半数病例发病于夏季与冬季。胃肠道感染与更高比例的住院时间延长相关。入院时存在重度运动功能缺损的患者，其病情改善比例更低。通过多变量模型拟合验证了上述研究结果。研究结论：住院时间延长与既往胃肠道感染存在关联，而入院时伴有重度运动功能缺损的患者病情改善程度更差。在秘鲁这类低收入地区，亟需建立前瞻性多中心监测系统以开展吉兰-巴雷综合征病例的监测工作。