Walgaard et al reported the modified Erasmus GBS Outcome Score (mEGOS) for evaluating a patient with Guillain-Barre Syndrome. This can help to identify a patient with a poor prognosis early in its course. The authors are from Erasmus Medical Center in The Netherlands.
Patient selection: Guillain-Barre syndrome
Outcome: inability to walk at 4 weeks, 3 months and 6 months
Parameters:
(1) age at onset in years
(2) preceding diarrhea
(3) Medical Research Council (MRC) sumscore at hospital admission
(4) Medical Research Council (MRC) sumscore at day 7 of admission
|
Parameter
|
Finding
|
Points
|
|
age at onset
|
<= 40 years
|
0
|
|
|
41 to 60 years
|
1
|
|
|
> 60 years
|
2
|
|
preceding diarrhea
|
no
|
0
|
|
|
yes
|
1
|
|
MRC on admission
|
0 to 30
|
6
|
|
|
31 to 40
|
4
|
|
|
41 to 50
|
2
|
|
|
51 to 60
|
0
|
|
MRC on day 7
|
0 to 30
|
9
|
|
|
31 to 40
|
6
|
|
|
41 to 50
|
3
|
|
|
51 to 60
|
0
|
score for admission =
= (points for age) + (points for diarrhea) + (points for MRC score on admission)
score for day 7 =
= (points for age) + (points for diarrhea) + (points for MRC score on day 7)
Interpretation:
• minimum scores: 0
• maximum admission score: 9
• maximum day 7 score: 12
• The higher the score the worse the long-term outcome.
The authors show multiple curves showing how each score correlates with outcomes at 4 weeks, 3 months and 6 months. The 7-day score predicts the inability to walk at 6 months as:
|
Score
|
Percent
|
|
0
|
0.65
|
|
1
|
1.3
|
|
2
|
1.83
|
|
3
|
3.0
|
|
4
|
5.2
|
|
5
|
7.8
|
|
6
|
11.7
|
|
7
|
17.7
|
|
8
|
24.7
|
|
9
|
33.1
|
|
10
|
44.2
|
|
11
|
54.5
|
|
12
|
64.9
|
Performance:
• The area under the ROC curve for the admission score is 0.73 to 0.77.
• The area under the ROC curve for the day 7 score is 0.84 to 0.87.
