Old age, comorbidities may delay diagnosis of Guillain-Barré syndrome

Older patients, as well as those with malignancies or cardiovascular diseases, may experience substantial diagnostic delay for Guillain-Barré syndrome (GBS), a recent study has found.

Researchers conducted a retrospective review of the medical records of 140 GBS patients. Participants were divided into two according to how soon diagnosis was delivered: early (≤14 days from symptom onset) and late (>14 days after onset). Comorbidities were assessed using the age-adjusted Charlson comorbidity index (ACCI).

Most patients (n=117) received an early diagnosis of GBS, while 23 were diagnosed more than 2 weeks after symptom onset. The former group was significantly younger than the latter (mean age at diagnosis, 49.1 vs 61.8 years; p=0.001). A CCI score ≥3 was also significantly more common in the late diagnosis group (26.1 percent vs 5.1 percent; p=0.01).

Linear regression analysis confirmed that a higher ACCI score was associated positively and significantly with a longer time to GBS diagnosis (β, 1.636; p<0.001). Dichotomizing ACCI into low and high groups (score, 0 v s ≥1) revealed that even after adjusting for ocular or bulbar symptoms, high ACCI doubled the likelihood of delayed GBS diagnosis (hazard ratio, 2.08, 95 percent confidence interval, 1.45–3.00).

Of note, this delaying effect appears to be driven by malignancies (median duration to diagnosis, 5.0 vs 10.5 days; p=0.04) and cardiovascular disease (median duration to diagnosis, 5.0 vs 11.0 days; p=0.038).

“Physicians should consider the possibility of GBS in elderly patients with multiple comorbidities,” the researchers said.