A clinical prognostic scoring system for Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is an acute post-infectious immune-mediated peripheral neuropathy with a highly variable clinical course and outcome. We aimed to develop and validate a scoring system based on clinical characteristics in the acute phase of GBS to predict outcome at 6 months. We studied...

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Vydané v:Lancet neurology Ročník 6; číslo 7; s. 589 - 594
Hlavní autori: van Koningsveld, Rinske, Steyerberg, Ewout W, Hughes, Richard AC, Swan, Anthony V, van Doorn, Pieter A, Jacobs, Bart C
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England Elsevier Ltd 01.07.2007
Elsevier Limited
Predmet:
Adult
Aged
Apheresis
Area Under Curve
Disability
Disability Evaluation
Female
Follow-Up Studies
Guillain-Barre syndrome
Guillain-Barre Syndrome - diagnosis
Guillain-Barre Syndrome - epidemiology
Humans
Immunoglobulins
Infections
International Cooperation
Male
Middle Aged
Neurology
Peripheral neuropathy
Pilot Projects
Plasma
Predictive Value of Tests
Prognosis
Randomized Controlled Trials as Topic
Reproducibility of Results
Retrospective Studies
Severity of Illness Index
Steroids
ISSN:1474-4422, 1474-4465
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Shrnutí:Guillain-Barré syndrome (GBS) is an acute post-infectious immune-mediated peripheral neuropathy with a highly variable clinical course and outcome. We aimed to develop and validate a scoring system based on clinical characteristics in the acute phase of GBS to predict outcome at 6 months. We studied patients with GBS who were unable to walk independently. A derivation set included 388 patients from two randomised controlled trials and one pilot study. Potential predictors were assessed for their association with the inability to walk independently at 6 months. A simple clinical scoring system was developed on the basis of regression coefficients of predictors in a multivariable logistic regression model. Model performance was quantified with respect to discrimination (area under receiver operating characteristics curve, AUC) and calibration (graphically). We validated our scoring system in a set of 374 patients from another randomised trial. We included three variables that were predictive of poor outcome at 6 months in our model: age, preceding diarrhoea, and GBS disability score at 2 weeks after entry. Scores ranged from 1 to 7, with three categories for age, two for diarrhoea, and five for GBS disability score at 2 weeks. Predictions corresponding to these prognostic scores ranged from 1% to 83% for the inability to walk independently at 6 months. Predictions agreed well with observed outcome frequencies (adequate calibration) and showed a very good discriminative ability (AUC 0·85) in both data sets. A simple scoring system for patients with GBS, based on three clinical characteristics, accurately predicts outcome at 6 months. The system could be used to counsel individual patients and identify high-risk groups to guide future trials.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1474-4422
1474-4465
DOI:10.1016/S1474-4422(07)70130-8