Title : Association of dysautonomia and different risk factors in patients with GBS in a tertiary hospital
Abstract:
Background: Guillain-Barre syndrome (GBS) commonly presents with progressive ascending weakness of the extremities and can also present with dysautonomia, that is associated with longer hospital stay and higher mortality rates than those without dysautonomia.
Objectives: Our study aims to determine the risk factors for dysautonomia among patients with GBS and to compare their features on patients without dysautonomia.
Methods: We conducted a retrospective review of GBS patients admitted in a tertiary hospital in the Philippines from January 2013 to June 2022. The patient demographics, comorbidities, Expanded disability status scale, GBS variants, parameters of dysautonomia, treatment and outcome were recorded and analyzed.
Results: Seventy-one patients were included and 49% were noted to develop dysautonomia with a higher incidence in males. There was an increased prevalence of dysautonomia in a year increase in age and a point increase in EDSS during admission. Respiratory infection is the most frequent antecedent event, and the predominant variant was AIDP, but there was no association between GBS variants to the development of dysautonomia. Hypertension was the most prominent manifestation of dysautonomia. However, hypertension and alcoholism showed to decrease the odds of developing dysautonomia.
Conclusions: Dysautonomia is common in patients with GBS however there were no predetermined clinical features or variables that can predict its development except in advance in age showing an increase in risk. There was no link between comorbidities and GBS variants on the development of dysautonomia, although, hypertension and alcoholism have shown a lower risk of dysautonomia in this study.
Audience Take Away Notes:
- Dysautonomia, characterized by various aberrancies of normal autonomic function, may occur in approximately 40-66% of patients diagnosed with GBS.
- The audience will be able to know the possible clinical and paraclinical risk factors associated with dysautonomia among GBS patients.
- Approximately half of clinically diagnosed GBS patients developed one or more features of dysautonomia, with increasing age being positively associated with its development.
- In Asian countries, AMAN appeared to be the most frequent variant in Japan, China, Korea, Turkey, and Bangladesh, while AIDP is mostly seen in Europe and North America. Interestingly, AIDP is the dominant variant in our cohort.
- The rate of autonomic dysfunction in our study was almost half of the cases (49%), with hypertension as the most prominent presentation (80%), which is in contrast with other studies identified mostly tachy or bradyarrythmias in up to 81% of cases.
- Dysautonomia may lead to longer hospital stay and higher odds of being in mechanical ventilator hence closer monitoring to this cohort of patients is advised.
- A further prospective and multicenter studies are needed to quantify the relationship between morbidity, mortality, and treatment option in GBS patients with dysautonomia.
