Association of Guillain-Barre syndrome with COVID-19 infection: An updated systematic review

Abu Baker Sheikh; Prabal Kumar Chourasia; Nismat Javed; Mehul Kumar Chourasia; Sajid S Suriya; Shubhra Upadhyay; Fatima Ijaz; Suman Pal; Narges Moghimi; Rahul Shekhar

doi:10.1016/j.jneuroim.2021.577577

Association of Guillain-Barre syndrome with COVID-19 infection: An updated systematic review

J Neuroimmunol. 2021 Jun 15:355:577577. doi: 10.1016/j.jneuroim.2021.577577. Epub 2021 Apr 18.

Authors

Affiliations

¹ Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America. Electronic address: absheikh@salud.unm.edu.
² Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA, United States of America.
³ Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
⁴ School of Medicine, Ninewells Hospital, University of Dundee, UK.
⁵ Department of Neurology, University of New Mexico, Albuquerque, NM, United States of America.
⁶ Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America.

Abstract

Objective: The systematic review aimed to determine demographic characteristics, clinical features, lab evaluation, management and complications of the studies focusing on Guillain-Barre syndrome (GBS) as a sequele of novel coronavirus (COVID-19) infection.

Methods: After protocol registration, PubMed, Web of Science and Cumulative Index to Nursing & Allied Health Literature (CINHAL) databases were searched for relevant articles using MeSH key-words and imported into referencing/review softwares. The data, regarding demographic and clinical characteristics, diagnostic workup and management, was analyzed in International Business Machines (IBM) Statistics SPSS 21. Many statistical tests, such as t-test and the Mann-Whitney U test, were used. P < 0.05 was considered significant.

Results: We identified 64 relevant articles. The mean age of the patients was 56 ± 16 years; the majority were males (64.9%). Among the neurological findings, paresthesia was the most typical symptom (48.9%). Most of the patients had been diagnosed by reverse transcriptase-polymerase chain reaction (RT-PCR) (69.2%). Two-third of the patients received immunoglobulins (IVIg) (77.7%). Although functions recovered in most patients, there were four patients with facial diplegia during follow-up (4.26%). Acute inflammatory demyelinating polyneuropathy (AIDP) was more likely to be associated with paresis of the lower extremity (p < 0.05) and higher levels of glucose on cerebrospinal fluid (CSF) analysis (p < 0.05). These patients were more likely to receive IVIg (p < 0.05) and develop respiratory insufficiency, subsequently (p < 0.05).

Conclusions: GBS is being recognized as one of the many presentations of the COVID-19 infection. Although the common form is AIDP that might lead to complications, other variants are possible as well, and more studies are needed to focus on those subvariants.

Keywords: Acute inflammatory demyelinating polyneuropathy; COVID-19; Guillain-Barre syndrome; Miller-Fisher syndrome.

Publication types

Systematic Review

MeSH terms

COVID-19 / complications*
Guillain-Barre Syndrome / virology*
Humans
SARS-CoV-2