Clinical study| Volume 62, P195-198, April 2019

Outcomes of patients with Guillain Barre Syndrome – Experience from a tertiary care hospital of a developing Asian country and review of regional literature

Published:November 23, 2018DOI:


      • Outcomes of GBS in Pakistan are comparable to other Asian countries.
      • Frequency of poor outcomes in mechanically ventilated patients was higher compared to regional data.
      • Referral bias and hospital level practices can contribute to this observation.
      • Increasing age, areflexia and longer LOS may predict poor outcome in MV patients.


      Outcomes of Guillain Barre Syndrome (GBS), particularly those require mechanical ventilation have been reported from a number of Asian countries, albeit, scarcely from Pakistan. We conducted this study to determine the short-term outcomes of GBS and compare the results of mechanically ventilated and non-ventilated patients. Case records of patients admitted with GBS during 2011–2016 at a large tertiary care centre of Pakistan were retrospectively reviewed. 216 patients satisfying inclusion criteria were included. Patients were divided into 2 groups based on requirement of MV (MV and non-MV group). Short term outcomes were assessed by Modified Rankin Scale (MRS) at discharge, 2 weeks and 3 months and comparison done between MV and non-MV group. Outcome based on MRS score is categorized as good (MRS = 0–3) or poor (MRS = 4–6). Requirement for MV was noted in 24.5%. MV patients had severe weakness at presentation, longer length of hospital stay (LOS) and higher frequency of in-hospital complications. Overall mortality was 7.9%. Good outcomes at discharge and at 3 months were noted in significantly higher frequency in non-MV group (50.3% and 93.2% respectively) as compared to MV group (11.3% and 33.3% respectively). In MV group, increasing age, areflexia and longer LOS stay were found as independent predictors of poor outcome. Overall outcomes of GBS in our population are comparable to both regional and international studies. However, poor outcomes in MV group are seen in higher frequency in our study. Increasing age, areflexia and longer LOS may predict poor outcome in MV patients.


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        • Willison H.J.
        • Jacobs B.C.
        • Van Doorn P.A.
        Guillain-Barré syndrome.
        Lancet. 2016; 388: 717-727
        • Hughes R.A.
        • Swan A.V.
        • van Doorn P.A.
        Intravenous immunoglobulin for Guillain-Barré syndrome.
        Cochrane Database Syst Rev. 2014;
        • Witsch J.
        • Galldiks N.
        • Bender A.
        • Kollmar R.
        • Bösel J.
        • Hobohm C.
        • et al.
        Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation.
        J Neurol. 2013; 260: 1367-1374
        • Rajabally Y.A.
        • Uncini A.
        Outcome and its predictors in Guillain-Barré syndrome.
        J Neurol Neurosurg Psychiatry. 2012; 83: 711-718
        • Kulkantrakorn K.
        • Sukphulloprat P.
        Outcome of Guillain-Barré syndrome in tertiary care centers in Thailand.
        J Clinical Neuromuscular Dis. 2017; 19: 51-56
        • Kalita J.
        • Misra U.K.
        • Goyal G.
        • Das M.
        Guillain-Barré syndrome: subtypes and predictors of outcome from India.
        J Peripheral Nerv Syst. 2014; 19: 36-43
        • Verma R.
        • Chaudhari T.S.
        • Raut T.P.
        • Garg R.K.
        Clinico-electrophysiological profile and predictors of functional outcome in Guillain-Barre syndrome (GBS).
        J Neurol Sci. 2013; 335: 105-111
        • Zhang G.
        • Li Q.
        • Zhang R.
        • Wei X.
        • Wang J.
        • Qin X.
        Subtypes and prognosis of Guillain-Barré syndrome in southwest China.
        PLoS One. 2015; 10e0133520
        • Ishaque T.
        • Islam M.B.
        • Ara G.
        • Endtz H.P.
        • Mohammad Q.D.
        • Jacobs B.C.
        • et al.
        High mortality from Guillain-Barré syndrome in Bangladesh.
        J Peripheral Nerv Syst. 2017; 22: 121-126
        • Wong A.H.
        • Umapathi T.
        • Shahrizaila N.
        • Chan Y.C.
        • Kokubun N.
        • Fong M.K.
        • et al.
        The value of comparing mortality of Guillain-Barré syndrome across different regions.
        J Neurol Sci. 2014; 344: 60-2.17
        • Ancona P.
        • Bailey M.
        • Bellomo R.
        Characteristics, incidence and outcome of patients admitted to intensive care unit with Guillain-Barre syndrome in Australia and New Zealand.
        J Crit Care. 2018; 1: 58-64
        • Netto A.B.
        • Taly A.B.
        • Kulkarni G.B.
        • Rao G.U.
        • Rao S.
        Prognosis of patients with Guillain-Barré syndrome requiring mechanical ventilation.
        Neurol India. 2011; 59: 707
        • Shafqat S.
        • Khealani B.A.
        • Awan F.
        • Abedin S.E.
        Guillain-Barré syndrome in Pakistan: similarity of demyelinating and axonal variants.
        Eur J Neurol. 2006; 13: 662-665
        • Sharshar T.
        • Chevret S.
        • Bourdain F.
        • Raphaël J.C.
        French cooperative group on plasma exchange in Guillain-Barré Syndrome. Early predictors of mechanical ventilation in Guillain-Barré syndrome.
        Crit Care Med. 2003; 31: 278-283
        • Souayah N.
        • Nasar A.
        • Suri M.F.
        • Qureshi A.I.
        National trends in hospital outcomes among patients with Guillain-Barre syndrome requiring mechanical ventilation.
        J Clin Neuromuscular Dis. 2008; 10: 24-28
        • Asbury A.K.
        • Cornblath D.R.
        Assessment of current diagnostic criteria for Guillain-Barré syndrome.
        Ann Neurol. 1990; 27: S21-S24
        • Sulter G.
        • Steen C.
        • De Keyser J.
        Use of the Barthel index and modified Rankin scale in acute stroke trials.
        Stroke. 1999 1; 30: 1538-1541
        • Wu X.
        • Li C.
        • Zhang B.
        • Shen D.
        • Li T.
        • Liu K.
        • et al.
        Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome.
        Crit Care. 2015; 19: 310
        • Dhar R.
        • Stitt L.
        • Hahn A.F.
        The morbidity and outcome of patients with Guillain-Barré syndrome admitted to the intensive care unit.
        J Neurol Sci. 2008; 264: 121-128
        • Mahieu L.M.
        • Buitenweg N.
        • Beutels P.
        • De J.J.
        Dooy Additional hospital stay and charges due to hospital-acquired infections in a neonatal intensive care unit.
        J Hosp Infect. 2001; 47: 223-229
        • Alshekhlee A.
        • Hussain Z.
        • Sultan B.
        • Katirji B.
        Guillain-Barré syndrome incidence and mortality rates in US hospitals.
        Neurology. 2008; 70: 1608-1613
        • Van den Berg B.
        • Bunschoten C.
        • van Doorn P.A.
        • Jacobs B.C.
        Mortality in Guillain-Barre syndrome.
        Neurology. 2013; 80: 1650-1654
        • Netto A.B.
        • Taly A.B.
        • Kulkarni G.B.
        • Rao U.G.
        • Rao S.
        Mortality in mechanically ventilated patients of Guillain Barré Syndrome.
        Ann Indian Acad Neurol. 2011; 14: 262
        • Walgaard C.
        • Lingsma H.F.
        • Ruts L.
        • Van Doorn P.A.
        • Steyerberg E.W.
        • Jacobs B.C.
        Early recognition of poor prognosis in Guillain-Barre syndrome.
        Neurology. 2011; 76: 968-975
        • Hung S.K.
        • Hiew F.L.
        • Ramlan R.
        • Viswanathan S.
        • Puvanarajah S.
        Guillain-barre syndrome, variants and forms fruste: reclassification with new criteria.
        J Neurol Sci. 2017; 15: 1075-1076
        • Ye Y.
        • Wang K.
        • Deng F.
        • Xing Y.
        Electrophysiological subtypes and prognosis of Guillain-Barré syndrome in Northeastern China.
        Muscle Nerve. 2013; 47: 68-71
        • Van den Berg B.
        • Storm E.F.
        • Garssen M.J.
        • Blomkwist-Markens P.H.
        • Jacobs B.C.
        Clinical outcome of Guillain-Barré syndrome after prolonged mechanical ventilation.
        J Neurol Neurosurg Psychiatry. 2018; 7 (jnnp-2018)
        • Khan F.
        • Pallant J.F.
        • Ng L.
        • Bhasker A.
        Factors associated with long-term functional outcomes and psychological sequelae in Guillain-Barre syndrome.
        J Neurol. 2010; 257: 2024-2031