Modified Erasmus GBS Respiratory Insufficiency Score: a simplified clinical tool to predict the risk of mechanical ventilation in Guillain-Barré syndrome

Correspondence to Professor Bart C Jacobs, Neurology and Immunology, Ee2289, Erasmus Medical Center, Rotterdam, 3015 GD, The Netherlands; [email protected]

WHAT IS ALREADY KNOWN ON THIS TOPIC

• The Erasmus Guillain-Barré syndrome (GBS) Respiratory Insufficiency Score (EGRIS) predicts the risk of respiratory failure in the first week of hospital admission in patients with GBS. A recent validation study within the International GBS Outcome Study (IGOS) showed that the EGRIS can be applied to the full spectrum of GBS, including mild cases and variants, and to patients from different regions. The original model, however, requires testing of 12 separate muscle groups and only includes clinical factors, while several studies have shown that Nerve Conduction Study parameters and biomarkers may add to the prediction of respiratory failure in GBS.

WHAT THIS STUDY ADDS

• This study provides an overview of the clinical and diagnostic factors associated with mechanical ventilation in GBS based on data collected in the IGOS-1500 cohort. Based on this analysis, we developed a simplified version of the EGRIS (mEGRIS), which can be used to predict the risk of respiratory failure in both the first week and other time points during follow-up with equal accuracy.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• The mEGRIS broadens the clinical applicability of the model in daily practice, as it only requires testing of three instead of 12 bilateral muscle groups without losing accuracy; can predict the risk of respiratory failure at any given time point during the first 2 months from disease onset; and also can be applied to GBS variants, mild forms and patients from different regions.

Introduction

Guillain-Barré syndrome (GBS) is a rapidly progressive, immune-mediated polyradiculoneuropathy.¹ During the acute phase of the disease 10%–30% of patients develop respiratory insufficiency requiring mechanical ventilation (MV).² Early recognition of patients at high risk of respiratory failure in GBS is crucial for triaging patients who need to be transferred to wards with stricter monitoring and for preventing pulmonary complications. In previous studies several features have been reported as predictors for the risk of MV,^{2 3} including facial and bulbar palsy,^4–6 autonomic dysfunction,⁴ severe muscle weakness at admission,^4–7 rapid disease progression,^{5 7} respiratory parameters (eg, vital capacity)^{6 8} and the presence of a...