ASSOCIATION OF HYPOALBUMINEMIA WITH DISEASE SEVERITY AND MECHANICAL VENTILATION IN GUILLAIN-BARRÉ SYNDROME

Abstract

Intro: Guillain-Barre syndrome (GBS), an immune-mediated polyneuropathy with variable clinical manifestation, prognosis and outcome. Despite of the proven efficacy of intravenous immunoglobulin (IVIg), 20% patients remain disabled with 2-19% mortality. Biomarker associated with clinical prognosis and outcome of GBS is needed to improve clinical management and effective treatment at early stage of GBS. In this study, we assessed the association between serum albumin levels, a relatively easily measurable biomarker of health and inflammation, and the clinical prognosis of GBS. Methods: We included 140 GBS patients in a prospective cohort study during 2019-2022 in Bangladesh. Detailed neurological examinations and measurement of serum albumin were done at baseline and pre-defined follow-up. Statistical comparisons between serum albumin and disease prognosis were performed using spearman correlation, ANOVA and student t-test. Findings: The median (IQR) age of 140 patients was 35 (21) years with male predominance (71%); 53 patients treated with IVIg, 29 with plasmapheresis and 58 with supportive care. Severity was higher (88%) and 48 patients required mechanical ventilation (32%). The median of serum albumin was significantly lower in severely affected patients compared to the mild cases (media [IQR]; 39.04 [7.9] vs. 42.14 [5.32], P= 0.001). Serum albumin levels had strong negative correlation with GBS disability score at enrolment (r= -0.663, P<0.0001) and moderate negative correlation at 4 weeks (r= -0.484, P<0.0001). Serum albumin level declined significantly at 2 weeks (P=0.002) and gradually increased significantly at 13 weeks (P<0.0001) and 26 weeks (P<0.0001) after treated with IVIg or plasmapheresis. Hypoalbuminemia (<34.0 g/L) was significantly associated with severity (P=0.010), mechanical ventilation and poor prognosis at 13 weeks (P=0.001) and 26 weeks (P<0.0001). Conclusion: In conclusion, serum albumin can be a strong prognostic biomarker to predict the disease severity and prognosis of GBS. Large sample size is required to validate the clinical relevance of the biomarkers in future.