TY - JOUR
T1 - Guillain-Barré syndrome and COVID-19
T2 - an observational multicentre study from two Italian hotspot regions
AU - Filosto, Massimiliano
AU - Cotti Piccinelli, Stefano
AU - Gazzina, Stefano
AU - Foresti, Camillo
AU - Frigeni, Barbara
AU - Servalli, Maria Cristina
AU - Sessa, Maria
AU - Cosentino, Giuseppe
AU - Marchioni, Enrico
AU - Ravaglia, Sabrina
AU - Briani, Chiara
AU - Castellani, Francesca
AU - Zara, Gabriella
AU - Bianchi, Francesca
AU - Del Carro, Ubaldo
AU - Fazio, Raffaella
AU - Filippi, Massimo
AU - Magni, Eugenio
AU - Natalini, Giuseppe
AU - Palmerini, Francesco
AU - Perotti, Anna Maria
AU - Bellomo, Andrea
AU - Osio, Maurizio
AU - Scopelliti, Giuseppe
AU - Carpo, Marinella
AU - Rasera, Andrea
AU - Squintani, Giovanna
AU - Doneddu, Pietro Emiliano
AU - Bertasi, Valeria
AU - Cotelli, Maria Sofia
AU - Bertolasi, Laura
AU - Fabrizi, Gian Maria
AU - Ferrari, Sergio
AU - Ranieri, Federico
AU - Caprioli, Francesca
AU - Grappa, Elena
AU - Broglio, Laura
AU - De Maria, Giovanni
AU - Leggio, Ugo
AU - Poli, Loris
AU - Rasulo, Frank
AU - Latronico, Nicola
AU - Nobile-Orazio, Eduardo
AU - Padovani, Alessandro
AU - Uncini, Antonino
N1 - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/11/6
Y1 - 2020/11/6
N2 - OBJECTIVE: Single cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19.METHODS: GBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered.RESULTS: Incidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum score (26.3±18.3 vs 41.4±14.8, p=0.006), higher frequency of demyelinating subtype (76.6% vs 35.3%, p=0.011), more frequent low blood pressure (50% vs 11.8%, p=0.017) and higher rate of admission to intensive care unit (66.6% vs 17.6%, p=0.002).CONCLUSIONS: This study shows an increased incidence of GBS during the COVID-19 outbreak in northern Italy, supporting a pathogenic link. COVID-19-associated GBS is predominantly demyelinating and seems to be more severe than non-COVID-19 GBS, although it is likely that in some patients the systemic impairment due to COVID-19 might have contributed to the severity of the whole clinical picture.
AB - OBJECTIVE: Single cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19.METHODS: GBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered.RESULTS: Incidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum score (26.3±18.3 vs 41.4±14.8, p=0.006), higher frequency of demyelinating subtype (76.6% vs 35.3%, p=0.011), more frequent low blood pressure (50% vs 11.8%, p=0.017) and higher rate of admission to intensive care unit (66.6% vs 17.6%, p=0.002).CONCLUSIONS: This study shows an increased incidence of GBS during the COVID-19 outbreak in northern Italy, supporting a pathogenic link. COVID-19-associated GBS is predominantly demyelinating and seems to be more severe than non-COVID-19 GBS, although it is likely that in some patients the systemic impairment due to COVID-19 might have contributed to the severity of the whole clinical picture.
U2 - 10.1136/jnnp-2020-324837
DO - 10.1136/jnnp-2020-324837
M3 - Article
C2 - 33158914
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
SN - 0022-3050
ER -