Relationship of Glycemic Status with Disease Severity in Guillain-Barré Syndrome

Journal of National Institute of Neurosciences Bangladesh Pub Date : 2020-12-14 DOI:10.3329/jninb.v6i2.50762

Mohammad A. Hossain, M. Hasan, M. Rahman, M. Baqui, Mahmudul Islam, M. Hakim

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Abstract

Background: Guillain-Barré syndrome (GBS) is an acute autoimmune polyneuroradiculopathy characterized by flaccid paralysis which may lead to respiratory failure requiring intensive care. Objective: The purpose of the present study was to explore the relationship between the fasting plasma glucose (FPG), hemoglobin A1c (HbA1c) and disease severity of GBS patients who are not known to have DM. Methodology: This cross-sectional study included adult GBS patients without having DM [age 35 (22-48) years, median (interqurtile range, IQR); 39 male 22 female] who were admitted to Neurology department, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from July 2018 to June 2019. Demographics, clinical data were noted and FPG, HbA1c were measured. Disease severity were assessed by the GBS disability scale ranging from 0 to 6 with increasing score reflecting increased disability. Results: Patients with more severe GBS (disability score ≥4, unable to walk) had higher frequency of elevated FPG >5.5 mmol/L (61.2%; 30/49) in comparison to those with less severe GBS (disability score ≤3, able to walk; FPG >5.5 mmol/L in 16.7%, 2/12; p=0.006). But distribution of HbA1c category was not different across the groups (disability score ≥4 vs. ≤3: HbA1c <5.7: 40% vs. 58%; 5.7-6.4: 50% vs. 25%; >6.4: 10% vs. 17%; p=0.296). Participants with elevated FPG were elder [elevated vs. normal FPG: 40 (28-54) vs. 25 (19-43) years; median (IQR), p=0.012] and had higher CSF glucose (p=0.002) than those with normal FPG, but there was no difference in respct of gender, MRC sum score, requirement of assisted ventilation, CSF protein, GBS subtypes and duration of hospital stay (p=not significant for all). Conclusions: Patients with severe GBS have higher frequency of elevated FPG but not HbA1c. An acute change in glucose metabolism may occur in GBS which needs further study. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 96-100

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格林-巴利综合征患者血糖状态与疾病严重程度的关系

背景:格林-巴勒综合征(GBS)是一种急性自身免疫性多神经根病变，以弛缓性麻痹为特征，可导致呼吸衰竭，需要重症监护。目的:本研究的目的是探讨未患糖尿病的GBS患者的空腹血糖(FPG)、血红蛋白A1c (HbA1c)与疾病严重程度之间的关系。方法:本横断面研究纳入了未患糖尿病的成人GBS患者[年龄35(22-48)岁，中位数(四分位范围，IQR);39男22女]，于2018年7月至2019年6月在孟加拉国达卡国立神经科学与医院研究所神经内科住院。记录人口统计学、临床数据，并测量FPG、HbA1c。采用GBS残疾量表评估疾病严重程度，评分从0到6分，分值越高，残疾程度越高。结果:GBS越严重(残疾评分≥4分，不能行走)患者FPG升高频率越高，>5.5 mmol/L (61.2%;30/49)与轻度GBS患者(残疾评分≤3，能够行走;FPG >5.5 mmol/L的占16.7%，2/12;p = 0.006)。但各组间HbA1c分类分布无差异(残疾评分≥4 vs≤3;HbA1c 6.4: 10% vs 17%;p = 0.296)。FPG升高的参与者年龄较大[FPG升高vs.正常:40 (28-54)vs. 25(19-43)岁;中位数(IQR)， p=0.012]，脑脊液葡萄糖高于FPG正常组(p=0.002)，但在性别、MRC总评分、辅助通气需求、脑脊液蛋白、GBS亚型和住院时间方面无差异(p=无显著性差异)。结论:严重GBS患者FPG升高的频率较高，但HbA1c升高的频率不高。GBS可能发生糖代谢的急性改变，这需要进一步研究。孟加拉国国家神经科学研究所学报，2020;6(2):96-100

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Journal of National Institute of Neurosciences Bangladesh

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