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.
Data availability statement
Data are available upon reasonable request.
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AP and AU contributed equally to the study and share senior authorship.
Contributors Conception and design of the study: MF, SCP, AP and AU. Drafting the manuscript and tables: SCP and MF. Statistical analysis: SG and SCP. Acquisition and analysis of clinical and neurophysiological data: MF, SCP, SG, CF, BF, MCS, MS, GC, EM, SR, CB, FCas, GZ, FB, UDC, RF, MFili, EM, GN, FP, AMP, AB, MO, GS, MC, AR, GS, PED, VB, MSC, LBe, GMF, SF, FR, FCap, EG, LBr, GDM, UL, LP, FR, NL and EN-O. Interpretation of electrophysiological data: AU. Critical revision of the article: NL, EN-O, AP and AU. Responsible for the overall content: MF, SCP, AP and AU. All authors discussed the results and contributed to the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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