Cargando…

Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain–Barré Syndrome

Background and objectives: Myasthenia gravis (MG) and Guillain–Barré Syndrome (GBS) are autoimmune neuromuscular disorders that may present as neuromuscular emergencies requiring mechanical ventilation and critical care. Comparative outcomes of these disease processes, once severe enough to require...

Descripción completa

Detalles Bibliográficos
Autores principales: Vellipuram, Anantha R., Cruz-Flores, Salvador, Chaudhry, Mohammad Rauf A., Rawla, Prashanth, Maud, Alberto, Rodriguez, Gustavo J., Kassar, Darine, Piriyawat, Paisith, Qureshi, Mohtashim A., Khatri, Rakesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681261/
https://www.ncbi.nlm.nih.gov/pubmed/31311172
http://dx.doi.org/10.3390/medicina55070375
_version_ 1783441691277000704
author Vellipuram, Anantha R.
Cruz-Flores, Salvador
Chaudhry, Mohammad Rauf A.
Rawla, Prashanth
Maud, Alberto
Rodriguez, Gustavo J.
Kassar, Darine
Piriyawat, Paisith
Qureshi, Mohtashim A.
Khatri, Rakesh
author_facet Vellipuram, Anantha R.
Cruz-Flores, Salvador
Chaudhry, Mohammad Rauf A.
Rawla, Prashanth
Maud, Alberto
Rodriguez, Gustavo J.
Kassar, Darine
Piriyawat, Paisith
Qureshi, Mohtashim A.
Khatri, Rakesh
author_sort Vellipuram, Anantha R.
collection PubMed
description Background and objectives: Myasthenia gravis (MG) and Guillain–Barré Syndrome (GBS) are autoimmune neuromuscular disorders that may present as neuromuscular emergencies requiring mechanical ventilation and critical care. Comparative outcomes of these disease processes, once severe enough to require mechanical ventilation, are not known. In this study, we compared the patients requiring mechanical ventilation in terms of in-hospital complications, length of stay, disability, and mortality between these two disease entities at a national level. Materials and Methods: Mechanically ventilated patients with primary diagnosis of MG (n = 6684) and GBS (n = 5834) were identified through retrospective analysis of Nationwide Inpatient Sample (NIS) database for the years 2006 to 2014. Results: Even though mechanically ventilated MG patients were older (61.0 ± 19.1 versus 54.9 ± 20.1 years) and presented with more medical comorbidities, they had lower disease severity on admission, as well as lower in-hospital complications sepsis, pneumonia, and urinary tract infections as compared with GBS patients. In the multivariate analysis, after adjusting for confounders including treatment, GBS patients had significantly higher disability (odds ratio (OR) 15.6, 95% confidence interval (CI) 10.9–22.2) and a longer length of stay (OR 3.48, 95% CI 2.22–5.48). There was no significant difference in mortality between the groups (8.45% MG vs. 10.0% GBS, p = 0.16). Conclusion: Mechanically ventilated GBS patients have higher disease severity at admission along with more in-hospital complications, length of stay, and disability compared with MG patients. Potential explanations for these findings include delay in the diagnosis, poor response to immunotherapy particularly in patients with axonal GBS variant, or longer recovery time after nerve damage.
format Online
Article
Text
id pubmed-6681261
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-66812612019-08-09 Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain–Barré Syndrome Vellipuram, Anantha R. Cruz-Flores, Salvador Chaudhry, Mohammad Rauf A. Rawla, Prashanth Maud, Alberto Rodriguez, Gustavo J. Kassar, Darine Piriyawat, Paisith Qureshi, Mohtashim A. Khatri, Rakesh Medicina (Kaunas) Article Background and objectives: Myasthenia gravis (MG) and Guillain–Barré Syndrome (GBS) are autoimmune neuromuscular disorders that may present as neuromuscular emergencies requiring mechanical ventilation and critical care. Comparative outcomes of these disease processes, once severe enough to require mechanical ventilation, are not known. In this study, we compared the patients requiring mechanical ventilation in terms of in-hospital complications, length of stay, disability, and mortality between these two disease entities at a national level. Materials and Methods: Mechanically ventilated patients with primary diagnosis of MG (n = 6684) and GBS (n = 5834) were identified through retrospective analysis of Nationwide Inpatient Sample (NIS) database for the years 2006 to 2014. Results: Even though mechanically ventilated MG patients were older (61.0 ± 19.1 versus 54.9 ± 20.1 years) and presented with more medical comorbidities, they had lower disease severity on admission, as well as lower in-hospital complications sepsis, pneumonia, and urinary tract infections as compared with GBS patients. In the multivariate analysis, after adjusting for confounders including treatment, GBS patients had significantly higher disability (odds ratio (OR) 15.6, 95% confidence interval (CI) 10.9–22.2) and a longer length of stay (OR 3.48, 95% CI 2.22–5.48). There was no significant difference in mortality between the groups (8.45% MG vs. 10.0% GBS, p = 0.16). Conclusion: Mechanically ventilated GBS patients have higher disease severity at admission along with more in-hospital complications, length of stay, and disability compared with MG patients. Potential explanations for these findings include delay in the diagnosis, poor response to immunotherapy particularly in patients with axonal GBS variant, or longer recovery time after nerve damage. MDPI 2019-07-15 /pmc/articles/PMC6681261/ /pubmed/31311172 http://dx.doi.org/10.3390/medicina55070375 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Vellipuram, Anantha R.
Cruz-Flores, Salvador
Chaudhry, Mohammad Rauf A.
Rawla, Prashanth
Maud, Alberto
Rodriguez, Gustavo J.
Kassar, Darine
Piriyawat, Paisith
Qureshi, Mohtashim A.
Khatri, Rakesh
Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain–Barré Syndrome
title Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain–Barré Syndrome
title_full Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain–Barré Syndrome
title_fullStr Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain–Barré Syndrome
title_full_unstemmed Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain–Barré Syndrome
title_short Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain–Barré Syndrome
title_sort comparative outcomes of respiratory failure associated with common neuromuscular emergencies: myasthenia gravis versus guillain–barré syndrome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681261/
https://www.ncbi.nlm.nih.gov/pubmed/31311172
http://dx.doi.org/10.3390/medicina55070375
work_keys_str_mv AT vellipuramananthar comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome
AT cruzfloressalvador comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome
AT chaudhrymohammadraufa comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome
AT rawlaprashanth comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome
AT maudalberto comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome
AT rodriguezgustavoj comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome
AT kassardarine comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome
AT piriyawatpaisith comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome
AT qureshimohtashima comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome
AT khatrirakesh comparativeoutcomesofrespiratoryfailureassociatedwithcommonneuromuscularemergenciesmyastheniagravisversusguillainbarresyndrome