Papri Nowshin, Doets Alex Y, Luijten Linda, Mohammad Quazi D, Endtz Hubert P, Lingsma Hester F, Jacobs Bart C, Islam Zhahirul
Laboratory of Gut-Brain Axis, icddr,b, Dhaka, Bangladesh.
Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
J Peripher Nerv Syst. 2024 Dec;29(4):428-440. doi: 10.1111/jns.12673. Epub 2024 Nov 24.
The aim of this study is to validate and perform a region-specific adjustment of the Erasmus GBS Respiratory Insufficiency Score (EGRIS) and identify potential predictors of prolonged mechanical ventilation (PMV) among Guillain-Barré syndrome (GBS) patients from Bangladesh.
We enrolled GBS patients from four prospective observational cohort studies conducted in Bangladesh. Accuracy of EGRIS to predict the requirement of MV in <7 days of study entry was evaluated. Model performance was assessed by discrimination (ability of the model to differentiate between patients who needed MV or not) and calibration (accuracy of absolute risk estimates). PMV was defined as duration of MV >14 days. Potential predictors for PMV were evaluated by Cox regression.
A total of 594 GBS patients aged ≥6 years old were enrolled; of whom 541 patients had complete EGRIS data prior to MV and were included in validation analysis. EGRIS correctly distinguished between patients requiring MV or not in 81% pairs (AUC = 0.81). EGRIS overestimated the probability of MV than the observed probability (41% vs. 20%) which was resolved by updating of the model intercept. Inability to flex hip at day 7 of start of MV was the strongest predictor for PMV with predicted probabilities of 82%.
EGRIS accurately predicts the need for MV in GBS patients from Bangladesh. This study developed a region-specific version of EGRIS and identified predictors of PMV. These findings can assist clinicians to identify patients at high risk of developing respiratory failure and requiring PMV to ensure timely intubation and tracheostomy of the patients in low resource settings.
本研究旨在验证并对伊拉斯谟吉兰 - 巴雷综合征呼吸功能不全评分（EGRIS）进行区域特异性调整，并确定孟加拉国吉兰 - 巴雷综合征（GBS）患者中机械通气时间延长（PMV）的潜在预测因素。
我们纳入了在孟加拉国进行的四项前瞻性观察队列研究中的GBS患者。评估了EGRIS在研究入组后<7天内预测机械通气需求的准确性。通过辨别力（模型区分需要机械通气和不需要机械通气患者的能力）和校准（绝对风险估计的准确性）来评估模型性能。PMV定义为机械通气持续时间>14天。通过Cox回归评估PMV的潜在预测因素。
共纳入594例年龄≥6岁的GBS患者；其中541例患者在机械通气前有完整的EGRIS数据，并纳入验证分析。EGRIS在81%的配对中正确区分了需要机械通气和不需要机械通气的患者（AUC = 0.81）。EGRIS高估了机械通气的概率，高于观察到的概率（41%对20%），这通过更新模型截距得到解决。机械通气开始第7天无法屈曲髋关节是PMV最强的预测因素，预测概率为82%。
EGRIS准确预测了孟加拉国GBS患者对机械通气的需求。本研究开发了EGRIS的区域特异性版本，并确定了PMV的预测因素。这些发现可帮助临床医生识别有发生呼吸衰竭和需要PMV高风险的患者，以确保在资源匮乏地区及时对患者进行插管和气管切开。
