Prediction of respiratory insufficiency in Guillain-Barré syndrome

Objective Respiratory insufficiency is a frequent and serious complication of the Guillain‐Barré syndrome (GBS). We aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the disease based on clinical characteristics available at hospita...

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Veröffentlicht in:Annals of neurology Jg. 67; H. 6; S. 781 - 787
Hauptverfasser: Walgaard, Christa, Lingsma, Hester F., Ruts, Liselotte, Drenthen, Judith, van Koningsveld, Rinske, Garssen, Marcel J. P., van Doorn, Pieter A., Steyerberg, Ewout W., Jacobs, Bart C.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.06.2010
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ISSN:0364-5134, 1531-8249, 1531-8249
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Abstract Objective Respiratory insufficiency is a frequent and serious complication of the Guillain‐Barré syndrome (GBS). We aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the disease based on clinical characteristics available at hospital admission. Methods Mechanical ventilation (MV) in the first week of admission was used as an indicator of acute stage respiratory insufficiency. Prospectively collected data from a derivation cohort of 397 GBS patients were used to identify predictors of MV. A multivariate logistic regression model was validated in a separate cohort of 191 GBS patients. Model performance criteria comprised discrimination (area under receiver operating curve [AUC]) and calibration (graphically). A scoring system for clinical practice was constructed from the regression coefficients of the model in the combined cohorts. Results In the derivation cohort, 22% needed MV in the first week of admission. Days between onset of weakness and admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors of MV. The prognostic model had a good discriminative ability (AUC, 0.84). In the validation cohort, 14% needed MV in the first week of admission, and both calibration and discriminative ability of the model were good (AUC, 0.82). The scoring system ranged from 0 to 7, with corresponding chances of respiratory insufficiency from 1 to 91%. Interpretation This model accurately predicts development of respiratory insufficiency within 1 week in patients with GBS, using clinical characteristics available at admission. After further validation, the model may assist in clinical decision making, for example, on patient transfer to an intensive care unit. ANN NEUROL 2010;67:781–787
AbstractList Objective Respiratory insufficiency is a frequent and serious complication of the Guillain‐Barré syndrome (GBS). We aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the disease based on clinical characteristics available at hospital admission. Methods Mechanical ventilation (MV) in the first week of admission was used as an indicator of acute stage respiratory insufficiency. Prospectively collected data from a derivation cohort of 397 GBS patients were used to identify predictors of MV. A multivariate logistic regression model was validated in a separate cohort of 191 GBS patients. Model performance criteria comprised discrimination (area under receiver operating curve [AUC]) and calibration (graphically). A scoring system for clinical practice was constructed from the regression coefficients of the model in the combined cohorts. Results In the derivation cohort, 22% needed MV in the first week of admission. Days between onset of weakness and admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors of MV. The prognostic model had a good discriminative ability (AUC, 0.84). In the validation cohort, 14% needed MV in the first week of admission, and both calibration and discriminative ability of the model were good (AUC, 0.82). The scoring system ranged from 0 to 7, with corresponding chances of respiratory insufficiency from 1 to 91%. Interpretation This model accurately predicts development of respiratory insufficiency within 1 week in patients with GBS, using clinical characteristics available at admission. After further validation, the model may assist in clinical decision making, for example, on patient transfer to an intensive care unit. ANN NEUROL 2010;67:781–787
Respiratory insufficiency is a frequent and serious complication of the Guillain-Barré syndrome (GBS). We aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the disease based on clinical characteristics available at hospital admission. Mechanical ventilation (MV) in the first week of admission was used as an indicator of acute stage respiratory insufficiency. Prospectively collected data from a derivation cohort of 397 GBS patients were used to identify predictors of MV. A multivariate logistic regression model was validated in a separate cohort of 191 GBS patients. Model performance criteria comprised discrimination (area under receiver operating curve [AUC]) and calibration (graphically). A scoring system for clinical practice was constructed from the regression coefficients of the model in the combined cohorts. In the derivation cohort, 22% needed MV in the first week of admission. Days between onset of weakness and admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors of MV. The prognostic model had a good discriminative ability (AUC, 0.84). In the validation cohort, 14% needed MV in the first week of admission, and both calibration and discriminative ability of the model were good (AUC, 0.82). The scoring system ranged from 0 to 7, with corresponding chances of respiratory insufficiency from 1 to 91%. This model accurately predicts development of respiratory insufficiency within 1 week in patients with GBS, using clinical characteristics available at admission. After further validation, the model may assist in clinical decision making, for example, on patient transfer to an intensive care unit.
Objective Respiratory insufficiency is a frequent and serious complication of the Guillain-Barre syndrome (GBS). We aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the disease based on clinical characteristics available at hospital admission. Methods Mechanical ventilation (MV) in the first week of admission was used as an indicator of acute stage respiratory insufficiency. Prospectively collected data from a derivation cohort of 397 GBS patients were used to identify predictors of MV. A multivariate logistic regression model was validated in a separate cohort of 191 GBS patients. Model performance criteria comprised discrimination (area under receiver operating curve [AUC]) and calibration (graphically). A scoring system for clinical practice was constructed from the regression coefficients of the model in the combined cohorts. Results In the derivation cohort, 22% needed MV in the first week of admission. Days between onset of weakness and admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors of MV. The prognostic model had a good discriminative ability (AUC, 0.84). In the validation cohort, 14% needed MV in the first week of admission, and both calibration and discriminative ability of the model were good (AUC, 0.82). The scoring system ranged from 0 to 7, with corresponding chances of respiratory insufficiency from 1 to 91%. Interpretation This model accurately predicts development of respiratory insufficiency within 1 week in patients with GBS, using clinical characteristics available at admission. After further validation, the model may assist in clinical decision making, for example, on patient transfer to an intensive care unit. ANN NEUROL 2010; 67:781-787.
Respiratory insufficiency is a frequent and serious complication of the Guillain-Barré syndrome (GBS). We aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the disease based on clinical characteristics available at hospital admission.OBJECTIVERespiratory insufficiency is a frequent and serious complication of the Guillain-Barré syndrome (GBS). We aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the disease based on clinical characteristics available at hospital admission.Mechanical ventilation (MV) in the first week of admission was used as an indicator of acute stage respiratory insufficiency. Prospectively collected data from a derivation cohort of 397 GBS patients were used to identify predictors of MV. A multivariate logistic regression model was validated in a separate cohort of 191 GBS patients. Model performance criteria comprised discrimination (area under receiver operating curve [AUC]) and calibration (graphically). A scoring system for clinical practice was constructed from the regression coefficients of the model in the combined cohorts.METHODSMechanical ventilation (MV) in the first week of admission was used as an indicator of acute stage respiratory insufficiency. Prospectively collected data from a derivation cohort of 397 GBS patients were used to identify predictors of MV. A multivariate logistic regression model was validated in a separate cohort of 191 GBS patients. Model performance criteria comprised discrimination (area under receiver operating curve [AUC]) and calibration (graphically). A scoring system for clinical practice was constructed from the regression coefficients of the model in the combined cohorts.In the derivation cohort, 22% needed MV in the first week of admission. Days between onset of weakness and admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors of MV. The prognostic model had a good discriminative ability (AUC, 0.84). In the validation cohort, 14% needed MV in the first week of admission, and both calibration and discriminative ability of the model were good (AUC, 0.82). The scoring system ranged from 0 to 7, with corresponding chances of respiratory insufficiency from 1 to 91%.RESULTSIn the derivation cohort, 22% needed MV in the first week of admission. Days between onset of weakness and admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors of MV. The prognostic model had a good discriminative ability (AUC, 0.84). In the validation cohort, 14% needed MV in the first week of admission, and both calibration and discriminative ability of the model were good (AUC, 0.82). The scoring system ranged from 0 to 7, with corresponding chances of respiratory insufficiency from 1 to 91%.This model accurately predicts development of respiratory insufficiency within 1 week in patients with GBS, using clinical characteristics available at admission. After further validation, the model may assist in clinical decision making, for example, on patient transfer to an intensive care unit.INTERPRETATIONThis model accurately predicts development of respiratory insufficiency within 1 week in patients with GBS, using clinical characteristics available at admission. After further validation, the model may assist in clinical decision making, for example, on patient transfer to an intensive care unit.
Author Drenthen, Judith
van Doorn, Pieter A.
Lingsma, Hester F.
Walgaard, Christa
Jacobs, Bart C.
Ruts, Liselotte
Steyerberg, Ewout W.
van Koningsveld, Rinske
Garssen, Marcel J. P.
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  surname: Walgaard
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  givenname: Hester F.
  surname: Lingsma
  fullname: Lingsma, Hester F.
  organization: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
– sequence: 3
  givenname: Liselotte
  surname: Ruts
  fullname: Ruts, Liselotte
  organization: Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
– sequence: 4
  givenname: Judith
  surname: Drenthen
  fullname: Drenthen, Judith
  organization: Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
– sequence: 5
  givenname: Rinske
  surname: van Koningsveld
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  organization: Department of Neurology, Elkerliek Ziekenhuis, Helmond, the Netherlands
– sequence: 6
  givenname: Marcel J. P.
  surname: Garssen
  fullname: Garssen, Marcel J. P.
  organization: Department of Neurology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
– sequence: 7
  givenname: Pieter A.
  surname: van Doorn
  fullname: van Doorn, Pieter A.
  organization: Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
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  givenname: Ewout W.
  surname: Steyerberg
  fullname: Steyerberg, Ewout W.
  organization: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
– sequence: 9
  givenname: Bart C.
  surname: Jacobs
  fullname: Jacobs, Bart C.
  email: b.jacobs@erasmusmc.nl
  organization: Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
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Issue 6
Keywords Nervous system diseases
Peripheral nerve disease
Guillain-Barré syndrome
Prediction
Inflammatory disease
Language English
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References Hughes RA, Cornblath DR. Guillain-Barré syndrome. Lancet 2005; 366: 1653-1666.
Sharshar T, Chevret S, Bourdain F, Raphael JC. Early predictors of mechanical ventilation in Guillain-Barré syndrome. Crit Care Med 2003; 31: 278-283.
The Italian Guillain-Barré Study Group. The prognosis and main prognostic indicators of Guillain-Barré syndrome. A multicentre prospective study of 297 patients. Brain 1996; 119 ( pt 6): 2053-2061.
Kleyweg RP, van der Meche FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve 1991; 14: 1103-1109.
Durand MC, Lofaso F, Lefaucheur JP, et al. Electrophysiology to predict mechanical ventilation in Guillain-Barré syndrome. Eur J Neurol 2003; 10: 39-44.
van Koningsveld R, Steyerberg EW, Hughes RA, et al. A clinical prognostic scoring system for Guillain-Barré syndrome. Lancet Neurol 2007; 6: 589-594.
Visser LH, van der Meche FG, Meulstee J, et al. Cytomegalovirus infection and Guillain-Barré syndrome: the clinical, electrophysiologic, and prognostic features. Dutch Guillain-Barré Study Group. Neurology 1996; 47: 668-673.
van Koningsveld R, Schmitz PI, Meche FG, et al. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial. Lancet 2004; 363: 192-196.
Steyerberg EW. Clinical prediction models. 1st ed. New York, NY: Springer-Verlag, 2008.
Ropper AH, Kehne SM. Guillain-Barré syndrome: management of respiratory failure. Neurology 1985; 35: 1662-1665.
Orlikowski D, Sharshar T, Porcher R, et al. Prognosis and risk factors of early onset pneumonia in ventilated patients with Guillain-Barré syndrome. Intensive Care Med 2006; 32: 1962-1969.
Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute polyneuropathy. Lancet 1978; 2: 750-753.
Garssen MP, van Koningsveld R, van Doorn PA, et al. Treatment of Guillain-Barré syndrome with mycophenolate mofetil: a pilot study. J Neurol Neurosurg Psychiatry 2007; 78: 1012-1013.
Funakoshi K, Kuwabara S, Odaka M, et al. Clinical predictors of mechanical ventilation in Fisher/Guillain-Barré overlap syndrome. J Neurol Neurosurg Psychiatry 2009; 80: 60-64.
Hadden RD, Cornblath DR, Hughes RA, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol 1998; 44: 780-788.
Dourado ME, Duarte RC, Ferreira LC, et al. Anti-ganglioside antibodies and clinical outcome of patients with Guillain-Barré syndrome in northeast Brazil. Acta Neurol Scand 2003; 108: 102-108.
Rees JH, Thompson RD, Smeeton NC, Hughes RA. Epidemiological study of Guillain-Barré syndrome in south east England. J Neurol Neurosurg Psychiatry 1998; 64: 74-77.
Winer JB, Hughes RA, Osmond C. A prospective study of acute idiopathic neuropathy: I. Clinical features and their prognostic value. J Neurol Neurosurg Psychiatry 1988; 51: 605-612.
Dhar R, Stitt L, Hahn AF. The morbidity and outcome of patients with Guillain-Barré syndrome admitted to the intensive care unit. J Neurol Sci 2008; 264: 121-128.
van der Meche FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group. N Engl J Med 1992; 326: 1123-1129.
Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990; 27( suppl): S21-S24.
Wijdicks EF, Henderson RD, McClelland RL. Emergency intubation for respiratory failure in Guillain-Barré syndrome. Arch Neurol 2003; 60: 947-948.
Orlikowski D, Terzi N, Blumen M, et al. Tongue weakness is associated with respiratory failure in patients with severe Guillain-Barré syndrome. Acta Neurol Scand 2009; 119: 364-370.
Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol 2001; 58: 893-898.
van Doorn PA, Ruts L, Jacobs BC. Clinical features, pathogenesis, and treatment of Guillain-Barré syndrome. Lancet Neurol 2008; 7: 939-950.
Durand MC, Porcher R, Orlikowski D, et al. Clinical and electrophysiological predictors of respiratory failure in Guillain-Barré syndrome: a prospective study. Lancet Neurol 2006; 5: 1021-1028.
Henderson RD, Lawn ND, Fletcher DD, et al. The morbidity of Guillain-Barré syndrome admitted to the intensive care unit. Neurology 2003; 60: 17-21.
Fletcher DD, Lawn ND, Wolter TD, Wijdicks EF. Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurology 2000; 54: 2311-2315.
Cheng BC, Chang WN, Chang CS, et al. Predictive factors and long-term outcome of respiratory failure after Guillain-Barré syndrome. Am J Med Sci 2004; 327: 336-340.
Kaida K, Kusunoki S, Kanzaki M, et al. Anti-GQ1b antibody as a factor predictive of mechanical ventilation in Guillain-Barré syndrome. Neurology 2004; 62: 821-824.
Souayah N, Nasar A, Suri MF, Qureshi AI. National trends in hospital outcomes among patients with Guillain-Barré syndrome requiring mechanical ventilation. J Clin Neuromuscul Dis 2008; 10: 24-28.
The Dutch Guillain-Barré Study Group. Treatment of Guillain-Barré syndrome with high-dose immune globulins combined with methylprednisolone: a pilot study. Ann Neurol 1994; 35: 749-752.
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References_xml – reference: The Italian Guillain-Barré Study Group. The prognosis and main prognostic indicators of Guillain-Barré syndrome. A multicentre prospective study of 297 patients. Brain 1996; 119 ( pt 6): 2053-2061.
– reference: van Doorn PA, Ruts L, Jacobs BC. Clinical features, pathogenesis, and treatment of Guillain-Barré syndrome. Lancet Neurol 2008; 7: 939-950.
– reference: Winer JB, Hughes RA, Osmond C. A prospective study of acute idiopathic neuropathy: I. Clinical features and their prognostic value. J Neurol Neurosurg Psychiatry 1988; 51: 605-612.
– reference: van der Meche FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group. N Engl J Med 1992; 326: 1123-1129.
– reference: Dourado ME, Duarte RC, Ferreira LC, et al. Anti-ganglioside antibodies and clinical outcome of patients with Guillain-Barré syndrome in northeast Brazil. Acta Neurol Scand 2003; 108: 102-108.
– reference: Hughes RA, Cornblath DR. Guillain-Barré syndrome. Lancet 2005; 366: 1653-1666.
– reference: Garssen MP, van Koningsveld R, van Doorn PA, et al. Treatment of Guillain-Barré syndrome with mycophenolate mofetil: a pilot study. J Neurol Neurosurg Psychiatry 2007; 78: 1012-1013.
– reference: Sharshar T, Chevret S, Bourdain F, Raphael JC. Early predictors of mechanical ventilation in Guillain-Barré syndrome. Crit Care Med 2003; 31: 278-283.
– reference: Fletcher DD, Lawn ND, Wolter TD, Wijdicks EF. Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurology 2000; 54: 2311-2315.
– reference: Durand MC, Porcher R, Orlikowski D, et al. Clinical and electrophysiological predictors of respiratory failure in Guillain-Barré syndrome: a prospective study. Lancet Neurol 2006; 5: 1021-1028.
– reference: Dhar R, Stitt L, Hahn AF. The morbidity and outcome of patients with Guillain-Barré syndrome admitted to the intensive care unit. J Neurol Sci 2008; 264: 121-128.
– reference: Funakoshi K, Kuwabara S, Odaka M, et al. Clinical predictors of mechanical ventilation in Fisher/Guillain-Barré overlap syndrome. J Neurol Neurosurg Psychiatry 2009; 80: 60-64.
– reference: Rees JH, Thompson RD, Smeeton NC, Hughes RA. Epidemiological study of Guillain-Barré syndrome in south east England. J Neurol Neurosurg Psychiatry 1998; 64: 74-77.
– reference: Wijdicks EF, Henderson RD, McClelland RL. Emergency intubation for respiratory failure in Guillain-Barré syndrome. Arch Neurol 2003; 60: 947-948.
– reference: Kaida K, Kusunoki S, Kanzaki M, et al. Anti-GQ1b antibody as a factor predictive of mechanical ventilation in Guillain-Barré syndrome. Neurology 2004; 62: 821-824.
– reference: Orlikowski D, Terzi N, Blumen M, et al. Tongue weakness is associated with respiratory failure in patients with severe Guillain-Barré syndrome. Acta Neurol Scand 2009; 119: 364-370.
– reference: Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990; 27( suppl): S21-S24.
– reference: van Koningsveld R, Steyerberg EW, Hughes RA, et al. A clinical prognostic scoring system for Guillain-Barré syndrome. Lancet Neurol 2007; 6: 589-594.
– reference: Visser LH, van der Meche FG, Meulstee J, et al. Cytomegalovirus infection and Guillain-Barré syndrome: the clinical, electrophysiologic, and prognostic features. Dutch Guillain-Barré Study Group. Neurology 1996; 47: 668-673.
– reference: Steyerberg EW. Clinical prediction models. 1st ed. New York, NY: Springer-Verlag, 2008.
– reference: Kleyweg RP, van der Meche FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve 1991; 14: 1103-1109.
– reference: Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol 2001; 58: 893-898.
– reference: Souayah N, Nasar A, Suri MF, Qureshi AI. National trends in hospital outcomes among patients with Guillain-Barré syndrome requiring mechanical ventilation. J Clin Neuromuscul Dis 2008; 10: 24-28.
– reference: Durand MC, Lofaso F, Lefaucheur JP, et al. Electrophysiology to predict mechanical ventilation in Guillain-Barré syndrome. Eur J Neurol 2003; 10: 39-44.
– reference: Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute polyneuropathy. Lancet 1978; 2: 750-753.
– reference: van Koningsveld R, Schmitz PI, Meche FG, et al. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial. Lancet 2004; 363: 192-196.
– reference: Ropper AH, Kehne SM. Guillain-Barré syndrome: management of respiratory failure. Neurology 1985; 35: 1662-1665.
– reference: Henderson RD, Lawn ND, Fletcher DD, et al. The morbidity of Guillain-Barré syndrome admitted to the intensive care unit. Neurology 2003; 60: 17-21.
– reference: Hadden RD, Cornblath DR, Hughes RA, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol 1998; 44: 780-788.
– reference: Cheng BC, Chang WN, Chang CS, et al. Predictive factors and long-term outcome of respiratory failure after Guillain-Barré syndrome. Am J Med Sci 2004; 327: 336-340.
– reference: Orlikowski D, Sharshar T, Porcher R, et al. Prognosis and risk factors of early onset pneumonia in ventilated patients with Guillain-Barré syndrome. Intensive Care Med 2006; 32: 1962-1969.
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Snippet Objective Respiratory insufficiency is a frequent and serious complication of the Guillain‐Barré syndrome (GBS). We aimed to develop a simple but accurate...
Respiratory insufficiency is a frequent and serious complication of the Guillain-Barré syndrome (GBS). We aimed to develop a simple but accurate model to...
Objective Respiratory insufficiency is a frequent and serious complication of the Guillain-Barre syndrome (GBS). We aimed to develop a simple but accurate...
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StartPage 781
SubjectTerms Adult
Area Under Curve
Biological and medical sciences
Cohort Studies
Female
Guillain-Barre Syndrome - complications
Humans
Male
Medical sciences
Middle Aged
Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis
Neurology
Predictive Value of Tests
Probability
Reproducibility of Results
Respiration, Artificial - methods
Respiratory Insufficiency - diagnosis
Respiratory Insufficiency - etiology
Respiratory Insufficiency - rehabilitation
Retrospective Studies
Risk Factors
Severity of Illness Index
Young Adult
Title Prediction of respiratory insufficiency in Guillain-Barré syndrome
URI https://api.istex.fr/ark:/67375/WNG-V35Q1GMB-R/fulltext.pdf
https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fana.21976
https://www.ncbi.nlm.nih.gov/pubmed/20517939
https://www.proquest.com/docview/733126680
https://www.proquest.com/docview/754551029
Volume 67
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