Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh.
Nutrition and Clinical Services Division icddr,b Dhaka Bangladesh.
Ann Clin Transl Neurol. 2019 Jan 7;6(2):324-332. doi: 10.1002/acn3.706. eCollection 2019 Feb.
We investigated clinical, biological, and electrophysiological risk factors for mechanical ventilation (MV) and patient outcomes in Bangladesh using one of the largest, prospective Guillain-Barré syndrome (GBS) cohorts in developing world.
A total of 693 GBS patients were included in two GBS studies conducted between 2006 and 2016 in Dhaka, Bangladesh. Associations between baseline characteristics and MV were tested using Fisher's exact test, χ test, or Mann-Whitney -test, as appropriate. Risk factors for MV were assessed using multivariate logistic regression. Survival analysis was performed using Kaplan-Meier method; comparisons between groups performed using log-rank test.
Of 693 patients, 155 (23%) required MV (median age, 26 years; interquartile range [IQR] 17-40). Among the ventilated patients, males were predominant (68%) than females. The most significant risk factor for MV was bulbar involvement (adjusted odds ratio [AOR]:19.07; 95% CI = 89.00-192.57, = 0.012). Other independently associated factors included dysautonomia (AOR:4.88; 95% CI = 1.49-15.98, = 0.009) and severe muscle weakness at study entry (AOR:6.12; 95% CI = 0.64-58.57, = 0.048). At 6 months after disease onset, 20% of ventilated and 52% of non-ventilated patients ( < 0.001) had recovered completely or with minor symptoms. Mortality rate was significantly higher among ventilated patients than non-ventilated patients (41% vs. 7%, < 0.001).
Bulbar involvement, dysautonomia and severe muscle weakness were identified as the most important risk factors for MV among GBS patients from Bangladesh. The findings may help to develop predictive models for MV in GBS in developing countries to identify impending respiratory failure and proper clinical management of GBS patients.
我们使用在发展中国家最大的前瞻性吉兰-巴雷综合征（GBS）队列之一，研究了孟加拉国机械通气（MV）和患者结局的临床、生物学和电生理危险因素。
共有 693 例 GBS 患者纳入了 2006 年至 2016 年在孟加拉国达卡进行的两项 GBS 研究中。使用 Fisher 确切检验、卡方检验或 Mann-Whitney U 检验（视情况而定）检验基线特征与 MV 的相关性。使用多变量逻辑回归评估 MV 的危险因素。使用 Kaplan-Meier 方法进行生存分析；使用对数秩检验比较组间差异。
在 693 例患者中，有 155 例（23%）需要 MV（中位年龄 26 岁；四分位距 [IQR] 17-40）。在需要通气的患者中，男性多于女性（68%）。MV 的最重要危险因素是球部受累（调整优势比 [OR]：19.07；95%置信区间 [CI] = 89.00-192.57，= 0.012）。其他独立相关因素包括自主神经功能障碍（OR：4.88；95% CI = 1.49-15.98，= 0.009）和研究开始时严重肌无力（OR：6.12；95% CI = 0.64-58.57，= 0.048）。在疾病发病后 6 个月时，20%的通气患者和 52%的非通气患者（<0.001）完全或仅有轻微症状恢复。通气患者的死亡率明显高于非通气患者（41% vs. 7%，<0.001）。
球部受累、自主神经功能障碍和严重肌无力是孟加拉国 GBS 患者发生 MV 的最重要危险因素。这些发现可能有助于在发展中国家建立 GBS 患者 MV 预测模型，以识别即将发生的呼吸衰竭和对 GBS 患者的适当临床管理。
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