Date of Award

Winter 4-1-2020

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

DR. Girish Thunga

Second Advisor

Dr.(Brig) Sankar Prasad Gorthi

Abstract

Introduction: Guillain Barre syndrome (GBS) is a rare autoimmune neurological disorder in which the body’s immune system attacks part of its peripheral nervous system resulting in limb and cranial nerve weakness often with respiratory compromise and limitation on physical function. The worldwide incidence of GBS ranges from 0.81 to 1.89 cases per 100000 person-years. Various factors such as age, symptoms and disease form that influence the outcome of GBS have been previously studied. This study seeks the additional fundamental knowledge of the factors affecting clinical management and the outcome in patients with GBS. Objective: To identify factors affecting clinical management and the outcomes in patients with GBS Method: A retrospective observational study was conducted in tertiary care teaching hospital of Southern India. Institutional Ethics Committee approval was obtained prior to the study. GBS patients admitted between January 2014 to December 2019 wee identified from Medical Reord Department (MRD) patient files using International Classification of Diseases (ICD) code G61.0. Patient information on demographic, medical history, medication history, laboratory parameters, electrophysiological data, type of GBS, duration of hospitalization and drug treatment were retrieved from medical records. Factors associated with outcome were identified by multiple logistic regression and odds ratio (OR) was calculated. Results: Based on inclusion and exclusion criteria, 212 cases of GBS were included in the study. The mean age of the GBS patients was 39.92 ±20.09 years and majority of the patients were male (n=142, 67%). The most commonly prescribed regimen was Intravenous Immunoglobulin (IVIgG) plus physiotherapy/occupational therapy (n=79, 37.3%) in which 74 (93.7%) patients showed improvement. Patients with Acute Motor and Sensory Axonal Neuropathy (AMSAN) variant (Adjusted OR=2.652; 95% CI 0.677-10.393), hypertension (Adjusted OR=2.839 95% CI 0.986-8.175), who consume alcohol (Adjusted OR=4.457; 95% CI 1.342-14.799), developed sepsis (Adjusted OR= 8.685 95% CI 1.556-48.471), cardiac arrest (Adjusted OR= 6.020 95% CI 0.835-43.401)and were ventilated (Adjusted OR= 2.319 95% CI 0.739-7.277) were associated with risk of poor outcome. Whereas those with Miller Fisher Syndrome (MFS) variant (Adjusted OR=0.144; 95% CI 0.009-2.205) and diabetes mellitus (Adjusted OR=0.464 95% CI 0.135-1.587) showed better outcome. Conclusion: It was found that alcoholism, history of hypertension, development of sepsis and cardiac arrest, requirement of mechanical ventilation and AMSAN variant of GBS were potential risk factors for poor outcome in GBS patients. MFS variant and history of Diabetes mellitus were found to have a protective effect against the same.

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