Ishita Tiwari1, Areesha Alam2, Chandra Kanta1, Sciddhartha Koonwar1, Ravindra Kumar Garg3, Shweta Pandey3, Amita Jain4, Rashmi Kumar1. 1. Departments of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India. 2. Departments of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India. areeshaAR@gmail.com. 3. Departments of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India. 4. Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Abstract
AIM: To develop a score based on clinical and laboratory parameters in acute-phase of GBS to predict outcome at 6 months. METHODS: Clinical and laboratory assessment at admission including blood neutrophil-to-lymphocyte ratio (NLR), pre and post-immunotherapy serum albumin was prospectively performed in pediatric-GBS cases at a tertiary-care hospital over 1 year. Clinical features and laboratory test results were compared between children with complete (Hughes Disability Score; HDS ≤ 1) and incomplete recovery (HDS > 1) at 6 months from onset, using univariate and multivariate analysis. Area-under-receiver-operating-characteristic-curve (AUC) of predictors of prognosis and their optimal cutoffs were assessed. RESULTS: Forty-six patients were enrolled (mean age 69.1 ± 35.2 months; male 57.6%). Factors on admission that independently predicted poor-outcome at 6 months were older age, feeble voice, lower NLR and lower post-immunotherapy serum albumin. AUCs and optimal cutoffs of NLR and post-immunotherapy serum albumin for predicting disability at 6 months were 0.729, 0.781 and ≤ 1.65, ≤ 34.5 g/L, respectively. AUCs of clinical parameters such as older age and feeble voice were 0.749 and 0.713 respectively. King GBS outcomescore including all predictors had maximum AUC of 0.971 (95% CI 0.921-1.02). The score at cutoff ≥ 3 demonstrated excellent sensitivity (92.3%) and specificity (96.7%) to determine poor outcome. CONCLUSIONS: This new prognostic system may be beneficial in recognising children-at-risk of poor prognosis who may benefit from additional treatment.
AIM: To develop a score based on clinical and laboratory parameters in acute-phase of GBS to predict outcome at 6 months. METHODS: Clinical and laboratory assessment at admission including blood neutrophil-to-lymphocyte ratio (NLR), pre and post-immunotherapy serum albumin was prospectively performed in pediatric-GBS cases at a tertiary-care hospital over 1 year. Clinical features and laboratory test results were compared between children with complete (Hughes Disability Score; HDS ≤ 1) and incomplete recovery (HDS > 1) at 6 months from onset, using univariate and multivariate analysis. Area-under-receiver-operating-characteristic-curve (AUC) of predictors of prognosis and their optimal cutoffs were assessed. RESULTS: Forty-six patients were enrolled (mean age 69.1 ± 35.2 months; male 57.6%). Factors on admission that independently predicted poor-outcome at 6 months were older age, feeble voice, lower NLR and lower post-immunotherapy serum albumin. AUCs and optimal cutoffs of NLR and post-immunotherapy serum albumin for predicting disability at 6 months were 0.729, 0.781 and ≤ 1.65, ≤ 34.5 g/L, respectively. AUCs of clinical parameters such as older age and feeble voice were 0.749 and 0.713 respectively. King GBS outcomescore including all predictors had maximum AUC of 0.971 (95% CI 0.921-1.02). The score at cutoff ≥ 3 demonstrated excellent sensitivity (92.3%) and specificity (96.7%) to determine poor outcome. CONCLUSIONS: This new prognostic system may be beneficial in recognising children-at-risk of poor prognosis who may benefit from additional treatment.
Authors: Willem-Jan R Fokkink; Christa Walgaard; Krista Kuitwaard; Anne P Tio-Gillen; Pieter A van Doorn; Bart C Jacobs Journal: JAMA Neurol Date: 2017-02-01 Impact factor: 18.302