Tool may predict inability to walk in patients with Guillain-Barré syndrome
A validated tool was able to predict the inability to walk unaided at 4 and 26 weeks among patients with Guillain-Barré syndrome, according to study results published in Neurology.
The tool, called the modified Erasmus [Guillain-Barré (GBS)] Outcome Score (mEGOS), is a clinical model developed using data from Dutch patients.
“In our previous study, based on the first 1,000 patients included in the International GBS Outcome Study (IGOS), we found marked regional differences in the clinical presentation, disease course, subtypes and outcome of GBS,” Alex Y. Doets, MD, of the department of neurology at Erasmus Medical Center, the Netherlands, and colleagues wrote. “Western GBS patients most frequently showed the demyelinating subtype of GBS, with involvement of both sensory and motor nerves. In Asia the Miller Fisher syndrome was more frequent, and the overall outcome was better.”
The researchers sought to validate the mEGOS in the IGOS cohort, as well as to outline its performance in different regions. Further, they aimed to examine whether they could enhance the mEGOS predictions by applying adjustments based on region. They analyzed prospective data from the first 1,500 IGOS participants who were aged 6 years or older and incapable of independent walking.
Doets and colleagues also examined whether mEGOS at entry and week 1 was able to predict inability to walk unaided at 4 and 26 weeks among the full cohort and among regional subgroups. To do so, they measured model performance using discrimination (area under the received operating characteristic curve [AUC]) and calibrations (observed vs. predicted probability of inability to walk independently). They recalibrated the model containing the overall mEGOS score and did not change the individual predictive factors, which allowed them to improve the model predictions. Further, they assessed the individual factors’ predictive ability.
A total of 809 individuals met inclusion criteria for validation of mEGOS at entry (Europe/North America, n = 677; Asia, n = 76; other, n = 56) and 671 at week 1 (Europe/North America, n = 563; Asia, n = 65; other, n = 43). Doets and colleagues noted all regional subgroups had an AUC value greater than 0.7. They reported worse outcomes than predicted in the Europe/North America subgroup and better outcomes than predicted in Asia. They improved model accuracy via recalibration, which allowed for the development of a version tailored for Europe/North America. Among the IGOS cohort, the most significant predictors of poor outcome included severe limb weakness and higher age, similar to the initial mEGOS.
“Given the varying patient populations and clinical settings to which the mEGOS will be applied, it will remain important to pay attention to differences in predicted and observed outcomes, especially in situations where clinical decision-making is primarily driven by specific cut-off values for the predicted outcome,” Doets and colleagues wrote.