Autonomic Dysfunction in Guillain Barre Syndrome: development of a Risk Score Scale (P1.278)

OBJECTIVE: To evaluate prognostic factors for the development of autonomic dysfunction (AD) in patients with Guillain-Barre syndrome (GBS) and to develop a risk assessment scale. BACKGROUND: Autonomic dysfunction is an important morbidity and mortality factor amongst patients with GBS. There is clear evidence that the risk is greater amongst quadriplegic patients, with respiratory failure or bulbar deficit. However, information about prognostic factors for the development of AD is also lacking. DESIGN/METHODS: We conducted a retrospective analysis of all medical records of GBS patients admitted to our institution between 2006 and 2014. Demographic and clinical characteristics of the subjects were summarized with descriptive statistics, and between-group differences were assessed by means of t-test or Mann-Whitney test. A multivariable logistic regression model was built in a forward fashion including all variables significant at the 0.25 cutpoint in univariate analysis. A simple score system was developed and points were assigned to each variable based on the magnitude of its regression coefficient. A total AD risk score was then calculated for each individual as the sum of points for each variable. RESULTS: Patients who developed AD were more likely to have facial weakness, a lower MRC-Sum Score on admission (p<0.001), and pain. In the multivariate logistic regression model, all these variables were a significant predictor of AD. The final model had an appropriate calibration with a Hosmer-Lemeshow Goodness-of-fit Test with a p=0.06. The final model also provided with an excellent discrimination (C-statistic 0.82). The total score ranged from 0 to 4 and correlates to an increasing probability of developing AD. CONCLUSIONS: Our risk score scale allows us to precisely predict those patients who will develop AD. However, more studies are necessary to confirm its external validity. Study Supported by: Raul Carrea Institute for Neurological Research (FLENI) Disclosure: Dr. Wilken has nothing to disclose. Dr. Farez has received personal compensation for activities with Merck Serono. Dr. Carpani has nothing to disclose. Dr. Barroso has nothing to disclose.