Prevalence, clinical characteristics and outcomes of Guillain−Barré syndrome spectrum associated with COVID‐19: A systematic review and meta‐analysis

Palaiodimou, Lina; Stefanou, Maria‐Ioanna; Katsanos, Aristeidis H.; Fragkou, Paraskevi C.; Papadopoulou, Marianna; Moschovos, Christos; Michopoulos, Ioannis; Kokotis, Panagiotis; Bakirtzis, Christos; Naska, Androniki; Vassilakopoulos, Theodoros I.; Chroni, Elisabeth; Tsiodras, Sotirios; Tsivgoulis, Georgios

BACKGROUND AND PURPOSE: Mounting evidence supports an association between Guillain−Barré syndrome spectrum (GBSs) and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. However, GBSs in the setting of coronavirus disease 2019 (COVID‐19) remains poorly characterized, whilst GBSs prevalence amongst COVID‐19 patients has not been previously systematically evaluated using a meta‐analytical approach. METHODS: A systematic review and meta‐analysis of observational cohort and case series studies reporting on the occurrence, clinical characteristics and outcomes of patients with COVID‐19‐associated GBSs was performed. A random‐effects model was used to calculate pooled estimates and odds ratios (ORs) with corresponding 95% confidence intervals (CIs), compared to non‐COVID‐19, contemporary or historical GBSs patients. RESULTS: Eighteen eligible studies (11 cohorts, seven case series) were identified including a total of 136,746 COVID‐19 patients. Amongst COVID‐19 patients, including hospitalized and non‐hospitalized cases, the pooled GBSs prevalence was 0.15‰ (95% CI 0%–0.49‰; I (2) = 96%). Compared with non‐infected contemporary or historical controls, patients with SARS‐CoV‐2 infection had increased odds for demyelinating GBSs subtypes (OR 3.27, 95% CI 1.32%–8.09%; I (2) = 0%). In SARS‐CoV‐2‐infected patients, olfactory or concomitant cranial nerve involvement was noted in 41.4% (95% CI 3.5%–60.4%; I (2) = 46%) and 42.8% (95% CI 32.8%–53%; I (2) = 0%) of the patients, respectively. Clinical outcomes including in‐hospital mortality were comparable between COVID‐19 GBSs patients and non‐infected contemporary or historical GBSs controls. CONCLUSION: GBSs prevalence was estimated at 15 cases per 100,000 SARS‐CoV‐2 infections. COVID‐19 appears to be associated with an increased likelihood of GBSs and with demyelinating GBSs variants in particular.