Guillain-Barré syndrome (GBS) is an acute polyneuropathy with a variable degree of Another prognostic model (Erasmus GBS Outcome Scale) has been. e.g., the Medical Research Council Scale. Grade 5: outcome, caregivers, including medical professionals, may help Erasmus GBS Prognosis Score. 1. Abbreviation / Long Form: EGOS / Erasmus GBS Outcome Scale 3, , IVIG treatment and prognosis in Guillain-Barre syndrome. GBS, IVIG.
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Dotted lines represent reference range values of albumin 3. B, For comparison, the serum IgG levels in the same cohort of patients are shown reprinted with permission from Wiley 6 to convert to grams per liter, multiply by 0.
Boxes indicate medians with interquartile ranges IQRs ; whiskers according to the Tukey test1. C, Scatterplot showing the correlation between the change in albumin and IgG levels. D, Scatterplot showing the correlation between the albumin and IgG levels at 2 weeks after treatment. To convert albumin to grams per liter, multiply by More than one-third of the patients were hypoalbuminemic, but even low-normal albumin levels were associated with poor outcome.
Serum albumin was measured from January 13 to 20, Analysis was performed from February 25,to September 6, Patients misdiagnosed as having GBS were retrospectively excluded from the study. Serum samples were obtained before and after IVIG treatment at 4 standardized time points from patients. Albumin levels were determined by routine diagnostic turbidimetry and related to demographics and clinical course during a follow-up of 6 months.
Before treatment, the median serum albumin level was 4. Hypoalbuminemia was associated with an increased chance of respiratory failure before 16 [ Further studies are required to confirm that serum albumin can be used as a biomarker to monitor disease activity and treatment response to IVIG in patients with GBS. Nadir is typically reached within a number of days or weeks, followed by a recovery that is generally much slower and often incomplete.
Such a biomarker would allow a more personalized approach to monitor treatment efficacy and anticipate outcome. To further improve prognosis and assessment of treatment response, biomarkers reflecting IVIG efficacy are needed. For purposes of clinical practice, the measurement of such biomarkers should preferably be straightforward and accurate and align with routine diagnostic procedures.
In this study, we aimed to determine whether serum albumin levels can serve as a prognostic marker in patients with GBS treated with IVIG. We determined the variation in serum albumin levels over time and assessed the serum albumin levels in response to IVIG after treatment.
Finally, we analyzed whether circulatory albumin levels were related to disease severity and clinical outcome. The patients were included in 2 clinical trials previously conducted from May 5,through August 2,in which clinical data and serum samples were prospectively collected according to a predefined standard protocol.
All patients provided written informed consent after approval by the institutional review board of Erasmus University Medical Center Rotterdam. The database, including all participants, was deidentified before analyzing. Clinical condition of the patients during the trials was monitored using the Medical Research Council MRC sum score, ranging from 0 tetraparalysis to 60 normal strengthand by the GBS disability scale, ranging from 0 healthy to 6 deceased.
Serum albumin concentrations were determined by routine automated diagnostic turbidimetry using a clinical chemistry analyzer Hitachi ; Hitachi Ltd.
To compare the albumin levels at different time points, the Friedman analysis of variance with the Dunn post hoc test was used. To assess the possible influence of serum albumin on disease severity, 2 strategies were ggs.
In the first analysis, patients were stratified in tertiles based on the serum albumin level before or 2 weeks after commencing IVIG therapy.
In the second analysis, patients were divided into 2 groups: Kaplan-Meier analysis, stratified for the GBS disability score at entry or stratified for age groups Table 1was used to assess the ability to walk unaided at the end of follow-up. Subsequent Cox proportional hazards regression analysis was used to correct for a possible age effect. Logistic regression analysis was performed to assess bgs effect on disease severity and clinical outcome.
The syntax of previously developed prognostic models was used to assess the contribution of albumin. In the acute phase of GBS before treatment, circulatory albumin levels were within the reference range in most patients median, 4.
Two weeks after treatment with IVIG was started, serum albumin levels decreased compared with levels before treatment median, 3. After 3 months, serum albumin levels returned to reference range values in ourcome patients except in 2 2. At 6 months after treatment, the albumin levels were higher when compared with the pretreatment level median serum albumin, 4. There was no influence of concomitant methylprednisolone treatment on serum albumin levels median albumin, 3.
Rather than a negative correlation, in which increasing levels of IgG reduce the serum albumin concentration, a positive correlation was observed. This somewhat unexpected result also became apparent from the correlation between the IgG and albumin serum levels at 2 weeks Figure 1 D. To assess the potential of albumin as a biomarker for disease severity and outcome, patients were grouped according to their serum albumin levels.
Patients were allocated to 1 of 2 groups clinical hypoalbuminemia present or absent or divided into tertiles of approximately equal number based on the raw data to maximize the value of information also within the reference range values srasmus albumin.
This categorization based on serum albumin levels was performed both before and 2 weeks after IVIG. The groups based on pretreatment serum albumin levels significantly differed in respiratory failure and the MRC sum score at nadir Table 2.
Dividing the patients based on hypoalbuminemia vs normoalbuminemia yielded comparable results srasmus, a higher serum albumin level was associated with a better clinical course and reduced disease severity at the end of follow-up [defined by the same clinical grading factors given in Table 2 ].
Intensive care unit ICU admission and mechanical ventilation could potentially influence the serum albumin levels. erasmys
Erasmus GBS Outcome Scale (EGOS) – Allie: Abbreviation / Long Form Info.
Survival analysis Kaplan-Meier with respect to the ersamus required to improve 1 point on the GBS disability scale or the achievement of walking more than 10 m unaided during the trial follow-up 6 months was not significantly different for patients based on their pretreatment albumin levels eFigure 1 in the Supplement.
Patients who maintained a serum albumin level within low-normal or high-normal range after treatment recuperated faster than hypoalbuminemic patients 6 of patients [5. Multivariate analysis with clinical predictive factors Table 2 in prognostic models for GBS identified pretreatment and posttreatment serum albumin as independent factors.
The addition of serum albumin to the 3 models improved the predictive capability in this cohort of patients, as expressed in the area under the curve when compared with models without outcomr incorporation of serum albumin levels.
The area under the curve increased from 0. We correlated the serum levels of albumin in patients with GBS before and after standard high-dose IVIG therapy to clinical recovery. Before, but more evidently 2 weeks after, the start of IVIG treatment, serum albumin levels were significantly decreased, and low serum albumin levels were associated with a poorer clinical outcome. Subsequent logistic regression analysis identified albumin as an independent factor associated with outcome.
Low albumin levels in serum obtained before treatment revealed dcale limited but potentially relevant association with poor outcome, especially with respect to the chance of respiratory failure. The pretreatment albumin levels were associated with respiratory failure independent of the clinical factors in the EGRIS model.
These patients had a poor clinical outcome compared with patients with normal albumin levels.
In addition, in the sacle group, patients with low-normal levels defined as 3. Multiple regression analysis revealed that serum albumin levels at 2 weeks after treatment were an independent factor associated with respiratory failure and inability to walk at 3 and 6 months, improving the capability of the EGRIS and mEGOS for anticipating these outcomes.
In a healthy individual, serum albumin levels are kept within a well-defined reference range. The main causes of a reduction in serum albumin are increased catabolism, decreased production, and extravasation attributable to increased capillary permeability in the setting of inflammation or severe disease. In sscale present study, however, no association was found between an increase in serum IgG levels after IVIG and a decrease in albumin levels.
This finding may indicate that there is no direct competition for binding to the FcRn, and previous studies 24 – 26 found that human FcRn has distinct binding sites for IgG and albumin.
Aside from a potential association with IVIG pharmacokinetics, albumin has been explored as a marker for prognosis in numerous other diseases and is a well-known indicator of general health.
Our findings should now be validated in prospective studies, preferably with greater numbers of patients. Hence, only the pretreatment or posttreatment levels were required for final analysis. The latter limits, of course, the practical use in GBS given the often rapid disease development that calls for early intervention. In our analyses regarding the prognostic models, we did not address the potential problem of overfitting, and no independent cohort of patients was available to validate our findings.
Admission to the ICU could be an important factor in the reduction of serum albumin levels eg, fluid therapy or mechanical ventilationbut patients who have not been admitted to the ICU also had reduced serum albumin levels of prognostic value to clinical outcome. Finally, we cannot rule out potential bias caused by the recumbence of patients, which is known to expand the plasma volume and thereby lower serum protein levels.
However, this effect seems unlikely because levels of other erasmks proteins IgA and IgM did not decrease. This study found that serum albumin, often already in use as a routine diagnostic indicator of overall health eg, comprehensive metabolic panelis an independent outco,e associated with the short- and long-term prognosis of patients with GBS treated with IVIG.
Modified Erasmus GBS Outcome Score (EGOS) at day 7 of admission
The most auspicious finding is the prognostic value of pretreatment levels for the need for mechanical ventilation. Prospective studies should verify these findings to confirm the benefit of serum albumin as a biomarker for prognosis of GBS in clinical practice. Dr Fokkink had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Critical revision of the manuscript for important intellectual content: Conflict of Interest Disclosures: Dr Kuitwaard reported receiving unrestricted research grants from Baxalta and Grifols. No other disclosures were reported. This work was supported by grant W.
OR from the Prinses Beatrix Spierfonds. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. Age Influences Serum Albumin Levels. PubMed Google Scholar Crossref. Intravenous immune globulin in autoimmune and inflammatory diseases.
N Engl J Med. Biomarkers for axonal damage in immune-mediated neuropathy. J Neurol Neurosurg Psychiatry. Alteration of biochemical profiles after high-dose intravenous immunoglobulin administration in Kawasaki disease. Variations in serum hemoglobin, albumin, and electrolytes in patients receiving intravenous immunoglobulin therapy: Am J Clin Dermatol.
The major histocompatibility complex-related Fc receptor for IgG FcRn binds albumin and prolongs its lifespan.
Amyotrophic lateral sclerosis outcome measures and the role of albumin and creatinine: Serum albumin level predicts initial intravenous immunoglobulin treatment failure in Kawasaki disease.
Relationship between serum albumin level and aging in community-dwelling self-supported elderly population. J Nutr Sci Vitaminol Tokyo. Serum protein changes during the acute phase reaction.