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Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions
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  • Published on:
    Further research required to support a causative association between GBS and COVID-19
    • Stephen Keddie, Neurology SpR and Clinical Research Fellow Centre for neuromuscular disease, National Hospital for Neurology and Neurosurgery, UCLH, London.
    • Other Contributors:
      • Julia Pakpoor, Neurology SpR
      • Aisling Carr, Neurology Consultant
      • Michael P Lunn, Neurology consultant

    To the Editor

    We were interested to read the study of Filosto et al [1] concluding a significant link between Guillain-Barre Syndrome (GBS) and COVID-19 infection in Northern Italy at the peak of the 1st wave SARS-CoV2 pandemic. We urge caution in accepting such a causative conclusion using a retrospective observational study; causation is not conclusively proven and is drawn from potentially biased data and small case numbers of a rare condition, and a rate calculation without confidence intervals to infer uncertainty.

    Only 34 cases of GBS, of whom 30 were COVID-19 positive, are reported over a 2-month period, with a denominator population of 8,400,107. We calculated the 95% confidence intervals of the incidence rates as 0.08 per 100,000 per month (95% C.I.: 0.04-0.15) in 2019 and 0.2 per 100,000 per month (95% C.I.: 0.14-0.28) in 2020. The overlapping confidence intervals do not support a statistically significant increase in GBS rates from 2019 to 2020. Furthermore, the simple multiplication of the monthly rate by 12 to create an approximate annualised incidence potentially amplifies the inaccuracy. We suggest that the 2.6-fold difference in GBS incidence from 2019 to 2019 is prone to meaningful statistical error.

    During the initial stages of the pandemic the denominator of COVID-19 positive cases will have been under-reported because testing was limited to the symptomatic and presenting populations. We are told that 62,679 inhabitants of the regi...

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    Conflict of Interest:
    We have a similar paper due to be published with larger numbers and have found opposing conclusions.