Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions

Filosto, Massimiliano; Cotti Piccinelli, Stefano; Gazzina, Stefano; Foresti, Camillo; Frigeni, Barbara; Servalli, Maria Cristina; Sessa, Maria; Cosentino, Giuseppe; Marchioni, Enrico; Ravaglia, Sabrina; Briani, Chiara; Castellani, Francesca; Zara, Gabriella; Bianchi, Francesca; Del Carro, Ubaldo; Fazio, Raffaella; Filippi, Massimo; Magni, Eugenio; Natalini, Giuseppe; Palmerini, Francesco; Perotti, Anna Maria; Bellomo, Andrea; Osio, Maurizio; Scopelliti, Giuseppe; Carpo, Marinella; Rasera, Andrea; Squintani, Giovanna; Doneddu, Pietro Emiliano; Bertasi, Valeria; Cotelli, Maria Sofia; Bertolasi, Laura; Fabrizi, Gian Maria; Ferrari, Sergio; Ranieri, Federico; Caprioli, Francesca; Grappa, Elena; Broglio, Laura; De Maria, Giovanni; Leggio, Ugo; Poli, Loris; Rasulo, Frank; Latronico, Nicola; Nobile-Orazio, Eduardo; Padovani, Alessandro; Uncini, Antonino

OBJECTIVE: Single cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19. METHODS: GBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered. RESULTS: Incidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum score (26.3±18.3 vs 41.4±14.8, p=0.006), higher frequency of demyelinating subtype (76.6% vs 35.3%, p=0.011), more frequent low blood pressure (50% vs 11.8%, p=0.017) and higher rate of admission to intensive care unit (66.6% vs 17.6%, p=0.002). CONCLUSIONS: This study shows an increased incidence of GBS during the COVID-19 outbreak in northern Italy, supporting a pathogenic link. COVID-19-associated GBS is predominantly demyelinating and seems to be more severe than non-COVID-19 GBS, although it is likely that in some patients the systemic impairment due to COVID-19 might have contributed to the severity of the whole clinical picture.