Universidad Peruana de Ciencias Aplicadas, Lima, Perú.
Rev Peru Med Exp Salud Publica. 2024 Oct 21;41(3):247-258. doi: 10.17843/rpmesp.2024.413.13509.
Motivation for the study. It is unclear which variant of Guillain-Barré syndrome is mostly associated with adverse outcomes.
Main findings. Variants had longer time in MV (7.42 days longer), and hospitalization (3.11 days longer). By subgroups, we found that children with the axonal variant had a greater use of MV; whereas, the demyelinating variant was more frequent among adults in MV.
Implications. Our results could be used for the implementation of new public health policies, allowing health personnel to have a better knowledge of the prognosis of each variant and the necessary resources to face future outbreaks.
OBJECTIVES.: To determine the requirement and time to mechanical ventilation and Intensive Care Unit (ICU), hospitalization and hospitalization time, death and disability of the axonal variants of Guillain-Barré Syndrome (GBS) in comparison with the acute demyelinating variant in patients of all the ages.
MATERIALS AND METHODS.: The systematic review that included patients with GBS. The exposure variable was the axonal variants and the comparator was acute inflammatory demyelinating polyneuropathy (AIDP). The outcomes were the requirement and time on mechanical ventilation (MV), requirement and time in the ICU, hospitalization time, disability and death. The NewCasttle-Ottawa Scale (NOS) was used to assess risk of bias. A meta-analysis was conducted to calculate mean differences and relative risks (RR) with their 95% confidence intervals (CI) using inverse variances and random effects models.
RESULTS.: Of the 3116 articles found, 46 met the selection criteria. The time on MV was 7.42 days (95% CI: 0.36 to 1.48) and the hospitalization time was 3.11 (95% CI: 0.73 to 5.49) days for the axonal variants. The axonal variants had a RR of 0.47 (95% CI: 0.24 to 0.92) for the requirement of MV in adults, but it was 1.68 (95% CI: 1.25 to 2.25) in children. There was a high statistical heterogeneity.
CONCLUSIONS.: Axonal variants showed, on average, longer MV and hospitalization time, overall and by subgroups. A high MV requirement was found for axonal variants in children; it was lower for adults.
研究动机。尚不清楚哪种格林-巴利综合征变异型与不良结局的关联性最大。
主要发现。变异型患者使用机械通气（MV）的时间更长（长 7.42 天），住院时间也更长（长 3.11 天）。通过亚组分析，我们发现轴索性变异型患儿更常需要使用 MV；而脱髓鞘变异型则更常见于成年 MV 患者。
意义。我们的研究结果可用于制定新的公共卫生政策，使卫生人员更好地了解每种变异型的预后和应对未来疫情所需的资源。
比较各年龄段患者的急性轴索性格林-巴利综合征（GBS）与急性炎症性脱髓鞘性多发性神经病（AIDP）的 axonal 变异型的 MV 和重症监护病房（ICU）需求及时间、住院时间、住院时间、死亡率和残疾率。
系统综述纳入了 GBS 患者。暴露变量为 axonal 变异型，对照变量为急性炎症性脱髓鞘性多神经病（AIDP）。结果为机械通气（MV）需求和时间、入住 ICU 需求和时间、住院时间、残疾和死亡。采用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。使用逆方差和随机效应模型进行荟萃分析，计算均值差异和相对风险（RR）及其 95%置信区间（CI）。
在 3116 篇文章中，有 46 篇符合选择标准。axonal 变异型患者的 MV 时间为 7.42 天（95%CI：0.36 至 1.48），住院时间为 3.11 天（95%CI：0.73 至 5.49）。axonal 变异型在成人患者中对 MV 的需求 RR 为 0.47（95%CI：0.24 至 0.92），而在儿童患者中 RR 为 1.68（95%CI：1.25 至 2.25）。存在较高的统计学异质性。
Axonal 变异型患者的 MV 和住院时间总体上以及按亚组分析均较长。在儿童中，Axonal 变异型对 MV 的需求较高，而在成人中则较低。
