Association of dysautonomia and different risk factors in patients with Guillain-Barré syndrome in a tertiary hospital in the Philippines

Abstract Background Guillain-Barré syndrome (GBS) presents with progressive ascending weakness, but it can also present with dysautonomia such as tachycardia, blood pressure fluctuations, diaphoresis, ileus, and urinary retention. GBS patients with dysautonomia was observed to have longer hospital s...

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Main Authors: Gerald T. Pagaling, Lowrence Precious C. Dichoso, Nikolai Gil D. Reyes, Mario B. Prado
Format: Article
Language:English
Published: BMC 2025-01-01
Series:BMC Neurology
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Online Access:https://doi.org/10.1186/s12883-025-04029-3
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author Gerald T. Pagaling
Lowrence Precious C. Dichoso
Nikolai Gil D. Reyes
Mario B. Prado
author_facet Gerald T. Pagaling
Lowrence Precious C. Dichoso
Nikolai Gil D. Reyes
Mario B. Prado
author_sort Gerald T. Pagaling
collection DOAJ
description Abstract Background Guillain-Barré syndrome (GBS) presents with progressive ascending weakness, but it can also present with dysautonomia such as tachycardia, blood pressure fluctuations, diaphoresis, ileus, and urinary retention. GBS patients with dysautonomia was observed to have longer hospital stays and higher mortality rates than those without dysautonomia. We aimed to determine the risk factors for dysautonomia and its manifestations among patients with GBS and compared their features to those without dysautonomia. Methods We conducted a 10 year-retrospective review of GBS patients admitted at the Philippine General Hospital. The patient demographics, comorbidities, GBS disability status scale (GBS-DS), GBS variants, parameters of dysautonomia, treatment, and outcome were recorded and analyzed. Simple and multiple logistic regression analysis were conducted to determine the factors associated with dysautonomia and the relationships were expressed using odds ratio. Results 71 patients were included, and 49% developed dysautonomia. Hypertension and tachycardia were the most prominent manifestations. There was an increase in the odds of developing dysautonomia in a one-year increase in age (OR: 1.11, p = 0.001) and a point increase in GBS-DS (OR:1.65, p = 0.037) during admission. Pre-morbid hypertension (OR:0.13, p = 0.028) and alcoholism (OR: 0.17, p = 0.037) are shown to decrease the odds of developing dysautonomia. Although GBS patients with dysautonomia had longer hospital stay (12.33 days), it only predicts 5.5% of the variability. Discussions The prevalence of cardiovascular manifestations was postulated from cardiosympathetic hyperactivity between arterial baroreceptors, cardiac parasympathetic fibers, and preganglionic sympathetic vasomotor fibers. The protective mechanism of premorbid hypertension could be attributed to the prior intake of antihypertensive medications, which mitigate cardiosympathetic fluctuations, while the protective effect of alcoholism needs to be further studied. Conclusion Patients who are older and with a high GBS-DS on admission, prompt close monitoring for the development of dysautonomia. The protective effects of premorbid hypertension and alcoholism needs further evaluation. The odds of developing pneumonia and being on a mechanical ventilator, while not statistically significant, could contribute to longer hospital stay of patients with dysautonomia. A larger prospective study is warranted to confirm these results.
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spelling doaj-art-674d208d86be41e1a60495f853ba05852025-01-26T12:39:30ZengBMCBMC Neurology1471-23772025-01-012511810.1186/s12883-025-04029-3Association of dysautonomia and different risk factors in patients with Guillain-Barré syndrome in a tertiary hospital in the PhilippinesGerald T. Pagaling0Lowrence Precious C. Dichoso1Nikolai Gil D. Reyes2Mario B. Prado3Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines ManilaDepartment of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines ManilaDepartment of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines ManilaDepartment of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines ManilaAbstract Background Guillain-Barré syndrome (GBS) presents with progressive ascending weakness, but it can also present with dysautonomia such as tachycardia, blood pressure fluctuations, diaphoresis, ileus, and urinary retention. GBS patients with dysautonomia was observed to have longer hospital stays and higher mortality rates than those without dysautonomia. We aimed to determine the risk factors for dysautonomia and its manifestations among patients with GBS and compared their features to those without dysautonomia. Methods We conducted a 10 year-retrospective review of GBS patients admitted at the Philippine General Hospital. The patient demographics, comorbidities, GBS disability status scale (GBS-DS), GBS variants, parameters of dysautonomia, treatment, and outcome were recorded and analyzed. Simple and multiple logistic regression analysis were conducted to determine the factors associated with dysautonomia and the relationships were expressed using odds ratio. Results 71 patients were included, and 49% developed dysautonomia. Hypertension and tachycardia were the most prominent manifestations. There was an increase in the odds of developing dysautonomia in a one-year increase in age (OR: 1.11, p = 0.001) and a point increase in GBS-DS (OR:1.65, p = 0.037) during admission. Pre-morbid hypertension (OR:0.13, p = 0.028) and alcoholism (OR: 0.17, p = 0.037) are shown to decrease the odds of developing dysautonomia. Although GBS patients with dysautonomia had longer hospital stay (12.33 days), it only predicts 5.5% of the variability. Discussions The prevalence of cardiovascular manifestations was postulated from cardiosympathetic hyperactivity between arterial baroreceptors, cardiac parasympathetic fibers, and preganglionic sympathetic vasomotor fibers. The protective mechanism of premorbid hypertension could be attributed to the prior intake of antihypertensive medications, which mitigate cardiosympathetic fluctuations, while the protective effect of alcoholism needs to be further studied. Conclusion Patients who are older and with a high GBS-DS on admission, prompt close monitoring for the development of dysautonomia. The protective effects of premorbid hypertension and alcoholism needs further evaluation. The odds of developing pneumonia and being on a mechanical ventilator, while not statistically significant, could contribute to longer hospital stay of patients with dysautonomia. A larger prospective study is warranted to confirm these results.https://doi.org/10.1186/s12883-025-04029-3Guillain-Barré SyndromeDysautonomiaAutoimmune inflammatory demyelinating polyneuropathyIVIGPlasmapheresis
spellingShingle Gerald T. Pagaling
Lowrence Precious C. Dichoso
Nikolai Gil D. Reyes
Mario B. Prado
Association of dysautonomia and different risk factors in patients with Guillain-Barré syndrome in a tertiary hospital in the Philippines
BMC Neurology
Guillain-Barré Syndrome
Dysautonomia
Autoimmune inflammatory demyelinating polyneuropathy
IVIG
Plasmapheresis
title Association of dysautonomia and different risk factors in patients with Guillain-Barré syndrome in a tertiary hospital in the Philippines
title_full Association of dysautonomia and different risk factors in patients with Guillain-Barré syndrome in a tertiary hospital in the Philippines
title_fullStr Association of dysautonomia and different risk factors in patients with Guillain-Barré syndrome in a tertiary hospital in the Philippines
title_full_unstemmed Association of dysautonomia and different risk factors in patients with Guillain-Barré syndrome in a tertiary hospital in the Philippines
title_short Association of dysautonomia and different risk factors in patients with Guillain-Barré syndrome in a tertiary hospital in the Philippines
title_sort association of dysautonomia and different risk factors in patients with guillain barre syndrome in a tertiary hospital in the philippines
topic Guillain-Barré Syndrome
Dysautonomia
Autoimmune inflammatory demyelinating polyneuropathy
IVIG
Plasmapheresis
url https://doi.org/10.1186/s12883-025-04029-3
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