Prognostic factors of Guillain-Barre syndrome after intravenous immunoglobulin or plasma exchange

Objective: To determine the influence of clinical, laboratory, and electrodiagnostic factors on the prognosis of Guillain-Barre syndrome (GBS). Background: Identification of prognostic factors may lead to better selection of patients with a poor prognosis for new therapeutic trials. Methods: The authors studied 147 patients with GBS who participated in the Dutch GBS trial comparing the effect of TV immunoglobulins with plasma exchange (PE). Outcome was measured at 8 weeks because half of the patients had recovered independent locomotion by then and at 6 months, the endpoint of the study. Results: Multivariate logistic regression revealed the following factors predicting outcome (inability to walk independently) at 8 weeks: a preceding gastrointestinal illness (yes, no), age (greater than or equal to 50, <50 years), Medical Research Council sum score (<40, greater than or equal to 40) at the start of treatment, and-described for the first time-a recent cytomegalovirus (CMV) infection (yes, no). At 6 months, the same clinical factors were found, but an initial rapid progression of weakness also appeared to be a prognostic factor. Analysis of treatment interactions revealed that the effect of diarrhea was more pronounced in the PE-treated group. Conclusions: The main predictors of outcome in GBS are clinical factors. Diarrhea is an important poor predictor of outcome, especially for the PE-treated group, and a recent CMV infection predicts delayed early recovery.