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Predicting Outcome in Guillain-Barre Syndrome:International Validation of the Modified Erasmus GBS Outcome Score

机译:预测结果在格林-巴利综合症:国际验证修改伊拉斯谟GBS结果分数

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Background and objectives: The clinical course and outcome of the Guillain-Barré syndrome (GBS) are diverse and vary among regions. The modified Erasmus GBS Outcome Score (mEGOS), developed with data from Dutch patients, is a clinical model that predicts the risk of walking inability in patients with GBS. The study objective was to validate the mEGOS in the International GBS Outcome Study (IGOS) cohort and to improve its performance and region specificity.Methods: We used prospective data from the first 1,500 patients included in IGOS, aged ≥6 years and unable to walk independently. We evaluated whether the mEGOS at entry and week 1 could predict the inability to walk unaided at 4 and 26 weeks in the full cohort and in regional subgroups, using 2 measures for model performance: (1) discrimination: area under the receiver operating characteristic curve (AUC) and (2) calibration: observed vs predicted probability of being unable to walk independently. To improve the model predictions, we recalibrated the model containing the overall mEGOS score, without changing the individual predictive factors. Finally, we assessed the predictive ability of the individual factors.Results: For validation of mEGOS at entry, 809 patients were eligible (Europe/North America [n = 677], Asia [n = 76], other [n = 56]), and 671 for validation of mEGOS at week 1 (Europe/North America [n = 563], Asia [n = 65], other [n = 43]). AUC values were >0.7 in all regional subgroups. In the Europe/North America subgroup, observed outcomes were worse than predicted; in Asia, observed outcomes were better than predicted. Recalibration improved model accuracy and enabled the development of a region-specific version for Europe/North America (mEGOS-Eu/NA). Similar to the original mEGOS, severe limb weakness and higher age were the predominant predictors of poor outcome in the IGOS cohort.Discussion: mEGOS is a validated tool to predict the inability to walk unaided at 4 and 26 weeks in patients with GBS, also in countries outside the Netherlands. We developed a region-specific version of mEGOS for patients from Europe/North America.Classification of evidence: This study provides Class II evidence that the mEGOS accurately predicts the inability to walk unaided at 4 and 26 weeks in patients with GBS.Trial registration information: NCT01582763.
机译:背景和目的:临床课程格林-巴利综合征(GBS)的结果多元化和不同地区之间。伊拉斯谟GBS结果分数(mEGOS)开发来自荷兰的病人的数据,是一个临床模型预测步行能力的风险GBS患者。验证在国际GBS mEGOS结果研究(政府间组织)队列,并改善它性能和区域特异性。从1500年第一个使用未来的数据患者纳入政府间组织,≥6岁无法独立行走。是否mEGOS入口和星期1预测在4和26日无法独立行走周满队列和地区子组,使用2措施模型性能:(1)歧视:面积接受者操作特性曲线(AUC)(2)校准:观察和预测的概率无法行走独立。我们调整了包含整个模型mEGOS分数,不改变个人预测因素。个人的预测能力的因素。条目,809名患者(欧洲/北美的资格美国(n = 677)、亚洲(n = 76),其他(n =56]),和671年的验证mEGOS星期1(欧洲/北美(n = 563)、亚洲(n = 65),其他(n = 43))。地区的子组。子群,观察到的结果比预测;比预测。准确性和启用的发展有针对性对欧洲/北美版本(mEGOS-Eu / NA)。严重的肢体无力和更高的年龄了可怜的结果的主要预测因子政府间组织群体。预测在4和无法独立行走26周GBS患者,也在国家在荷兰。有针对性的版本mEGOS病人从欧洲/北美。证据:这项研究提供了二类的证据mEGOS准确预测能力在4和26周独立行走的病人GBS。NCT01582763。

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