Validation and adjustment of modified Erasmus GBS outcome score in Bangladesh

Nowshin Papri, Alex Y. Doets, Quazi D. Mohammad, Hubert P. Endtz, Hester F. Lingsma, Bart C. Jacobs, Zhahirul Islam*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objective: We have assessed and improved the performance of the modified Erasmus GBS Outcome Score (mEGOS) among patients with Guillain-Barré syndrome (GBS) from Bangladesh. Methods: Validation cohort consisted of patients with GBS from two prospective cohort studies in Bangladesh. Poor outcome was defined as being unable to walk independently at week 4 and week 26. We excluded patients able to walk independently, patients who died within the first week, or with missing GBS disability scores. Performance of mEGOS at entry and week 1 was determined based on the discriminative ability (ability to differentiate between patients able and unable to walk independently; measured using the area under the receiver operating characteristic curves [AUC]) and calibration (observed probability versus predicted probability of poor outcome). Results: A total of 506 patients aged ≥6-year-old were enrolled, with 471 and 366 patients included in mEGOS validation analysis at entry and week 1, respectively. The AUC values for predicting poor outcome (1) at week 4 were 0.69 (mEGOS entry) and 0.78 (mEGOS week 1) and (2) at week 26 were 0.67 (mEGOS entry) and 0.70 (mEGOS week 1). Mean predicted probabilities of poor outcome corresponded with observed outcomes except for the probability of poor outcome at week 4 which was overestimated by mEGOS week 1. This was resolved by updating the model intercept. Interpretation: The mEGOS shows valid outcome predictions among patients with GBS from Bangladesh. The model can aid the identification of patients at high risk of poor outcome and help to adequately allocate healthcare resources in low-resource settings.

Original languageEnglish
Pages (from-to)1264-1275
Number of pages12
JournalAnnals of Clinical and Translational Neurology
Volume9
Issue number8
Early online date30 Jul 2022
DOIs
Publication statusPublished - Aug 2022

Bibliographical note

Funding Information:
This research activity was funded by icddr,b and GBS-CIDP Foundation International. icddr,b is grateful to its core donors including the Governments of Bangladesh, Canada, Sweden, and the United Kingdom for providing core/unrestricted support for its operations and research. Q.D.M. received consulting honoraria from Annexon Biosciences for activities unrelated to this manuscript. Z.I. received restricted grant (number 1K43TW011447-01) support from Fogarty International Center and the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), and Annexon Biosciences for activities unrelated to the subject matter of this manuscript. B.C.J. received unrestricted support for research from GBS-CIDP Foundation International, Prinses Beatrix Spierfonds, EU Horizon 2020, Annexon Biosciences, CSL-Behring, Griffols, and Hansa Biopharma for activities unrelated to the subject matter of this manuscript. H.P.E. received unrestrictive support from EU Horizon 2020, the Bill and Melinda Gates Foundation and Fondation Mérieux for activities unrelated to the current manuscript. We are indebted to the neurologists who referred their patients to us. We thank the patients who participated in the study and provided their valuable data.

Funding Information:
This research activity was funded by icddr,b and GBS‐CIDP Foundation International. icddr,b is grateful to its core donors including the Governments of Bangladesh, Canada, Sweden, and the United Kingdom for providing core/unrestricted support for its operations and research. Q.D.M. received consulting honoraria from Annexon Biosciences for activities unrelated to this manuscript. Z.I. received restricted grant (number 1K43TW011447‐01) support from Fogarty International Center and the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), and Annexon Biosciences for activities unrelated to the subject matter of this manuscript. B.C.J. received unrestricted support for research from GBS‐CIDP Foundation International, Prinses Beatrix Spierfonds, EU Horizon 2020, Annexon Biosciences, CSL‐Behring, Griffols, and Hansa Biopharma for activities unrelated to the subject matter of this manuscript. H.P.E. received unrestrictive support from EU Horizon 2020, the Bill and Melinda Gates Foundation and Fondation Mérieux for activities unrelated to the current manuscript. We are indebted to the neurologists who referred their patients to us. We thank the patients who participated in the study and provided their valuable data.

Publisher Copyright:
© 2022 International Centre for Diarrhoeal Disease Research, Bangladesh. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.

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