title: Short-Term Prognosis of Mechanically Ventilated Patients With Guillain-Barré Syndrome Is Worsened by Corticosteroids as an Add-On Therapy.
abstract: Intravenous immunoglobulin (IVIg) has been proven most effective in treating Guillain-Barré syndrome (GBS). Corticosteroids as an add-on therapy have been prescribed in severe GBS cases. However, the efficacy of intravenous corticosteroids combined with IVIg in dealing with severe GBS remains unclear. We explored the therapeutic effects of different therapeutic regimens on the short-term prognosis of GBS patients, especially the severe cases.We retrospectively analyzed the clinical data of 527 adult patients with GBS who were prescribed to different treatments from 2003 to 2014. The therapeutic effect of a treatment was evaluated by the improvement of Hughes Functional Grading Scale (HFGS) and Medical Research Council (MRC) sum score.With comparable incidence of infectious complications (P > 0.05), more mechanically ventilated patients were found improvement after IVIg treatment than combination IVIg with intravenous corticosteroids (MRC: 97% vs. 72.4%, P < 0.05; HFGS: 97% vs. 72.4%, P < 0.05). As to bedridden patients without mechanical ventilation, incidence of infectious complications (P > 0.05) and ratio of patients who were improved after IVIg were insignificantly different from the combination therapy (MRC: 89.6% vs. 86.5%; HFGS: 69.6% vs. 61.5%; both P > 0.05), even if the intravenous corticosteroids were initiated within 7 days after onset (P > 0.05). In addition, supportive treatment was sufficient for patients who were able to walk with help (HFGS = 3) and mildly affected (HFGS < 3) when compared with IVIg and intravenous corticosteroids.IVIg is sufficient to GBS patients who are unable to walk (HFGS > 3), while corticosteroids are detrimental for short-term prognosis in mechanically ventilated patients when used in combination with IVIg. Further prospective and randomized studies are warranted to validate this finding.
authors.affiliation: From the Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China (XW, BZ, CL, DS, KL, JZ, H-LZ); and Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden (JZ).
authors.forename: Xiujuan
authors.initials: X
authors.lastname: Wu
authors.forename: Bing
authors.initials: B
authors.lastname: Zhang
authors.forename: Chunrong
authors.initials: C
authors.lastname: Li
authors.forename: Donghui
authors.initials: D
authors.lastname: Shen
authors.forename: Kangding
authors.initials: K
authors.lastname: Liu
authors.forename: Jie
authors.initials: J
authors.lastname: Zhu
authors.forename: Hong-Liang
authors.initials: HL
authors.lastname: Zhang
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D003907:Dexamethasone / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D020275:Guillain-Barre Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects; D008875:Middle Aged; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D003907:Dexamethasone; D008775:Methylprednisolone