Deciphering the prognostic role of serum immunoglobulin G in Guillain-Barré syndrome during intravenous immunoglobulin treatment.

Abstract

Background: Guillain-Barré syndrome (GBS) is associated with 20% rate of long-term disability. This study explores the pathophysiology of GBS and the mechanism of intravenous immunoglobulin (IVIg).

Objective: To investigate whether elevated immunoglobulin G (IgG) levels following IVIg administration are linked to improved recovery of independent walking at 6 months.

Material and methods: A retro-prospective observational study was conducted. IgG levels were measured before treatment, 7- and 30-days post-initiation. Binary regression analysis assessed the impact of individual factors on prognosis and sequelae. The Kaplan-Meier curve was used to evaluate the proportion of patients who couldn´t walk unaided.

Results: Forty-two patients were included. The mean baseline IgG level was 832.25 mg/dl, increasing to 3053.48 mg/dl at 7 days and decreasing to 1091.72 mg/dl at 30 days. IgG increases at 7 days were categorized into quartiles. Patients with a low increase in IgG levels (< 1945.5 mg/dl) at 7 days exhibited more severe clinical manifestations, including greater needs for invasive mechanical ventilation and increased autonomic dysfunction. Also had poorer walking outcomes at 6 months.

Conclusions: Lower increase in IgG levels at 7 days post-treatment is associated with a worse prognosis at 6 months, including a reduced likelihood of walking unaided.