Clinical Spectrum and Prognostic Predictors of Guillain-Barré Syndrome: A Prospective Observational Study From South India

Abstract

Introduction: Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy and a leading cause of acute flaccid paralysis. Though uncommon, it carries substantial morbidity and mortality. Indian prospective data remain limited, prompting this study to evaluate clinical patterns, complications, and prognostic determinants in a tertiary care cohort. Study: This prospective observational study was conducted at Madras Medical College, Chennai, between May 2024 and May 2025. Ninety consecutive patients aged 12 years and above fulfilling the Asbury and Cornblath criteria for GBS were included. Clinical details, cerebrospinal fluid (CSF) parameters, and electrophysiological subtypes were documented. Patients received intravenous immunoglobulin (IVIG), plasma exchange (PLEX), or supportive care. Outcomes assessed were ventilation requirement, complications, mortality, and functional status at discharge using the modified Rankin Scale (mRS). Results: Ninety patients (mean age 38.5 years) were studied, with a slight male predominance. Antecedent infections were common, mainly respiratory or gastrointestinal. Most patients (over 80%) presented with ascending symmetrical weakness, predominantly of the pure motor type. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the commonest electrophysiological subtype, followed by axonal variants. About one-fourth required intensive care unit (ICU) admission, and one-fifth needed mechanical ventilation. At discharge, one-third regained independent ambulation, while 9% died. Poor outcomes were associated with older age, cranial nerve and autonomic involvement, and axonal forms. Conclusion: GBS in this cohort predominantly affected young to middle-aged adults, with classical ascending weakness and AIDP as the commonest pattern, though axonal forms were frequent. One-third recovered well, but nearly half remained disabled and 9% died. Early recognition of predictors such as older age, cranial nerve palsy, autonomic dysfunction, and axonal subtypes is crucial for risk stratification and intensive management.