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.
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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.
Patient consent for publication Not required.
Ethics approval This study has been approved by Brescia Hospital Ethics Committee. Given the difficulty in systematically obtaining informed consent and given the great public interest of the project, the research was conducted in the context of the authorisations guaranteed by Article 89 of the GDPR EU Regulation 2016/679.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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