The predictive value of early clinical and electrodiagnostic markers on short- and long-term functional outcomes in Guillain-Barré Syndrome: a systematic review and exploratory meta-analysis.

Authors

Pricilla Yani Gunawan, Jeremiah Hilkiah Wijaya

Published in

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. Volume 155. Pages 112348. Oct 25, 2026. Epub Oct 25, 2026.

Abstract

Guillain-Barré Syndrome (GBS) presents with highly variable recovery trajectories. Early identification of prognostic markers is crucial for optimizing patient management and anticipating severe complications.
A systematic search of PubMed, EMBASE, and Scopus was conducted in accordance with PRISMA 2020 guidelines. Studies reporting early clinical or electrodiagnostic predictors of functional outcomes in confirmed GBS patients were eligible. Study selection, data extraction, and risk-of-bias assessment were each performed independently and in duplicate by both authors (PYG and JHW). Methodological quality was assessed using the Newcastle-Ottawa Scale. Exploratory meta-analyses were performed using standardized mean differences (SMD) for functional recovery and pooled proportions for mechanical ventilation incidence. Effect sizes were oriented so that a positive SMD consistently denotes poorer functional status in the poor-prognosis group. Functional recovery was additionally stratified a posteriori by outcome assessment timepoint (short-term, 1-4 weeks; long-term, 3-6 months).
Seven studies (n = 398 patients) were included. High GBS disability scores, reduced MRC sum scores, elevated mEGOS and EGRIS values, and markedly reduced CMAP amplitudes consistently predicted poor functional recovery. In the exploratory pooled analysis, the SMD for functional recovery was 2.33 (95% CI: 0.34-4.32; I² = 85.1%; k = 5), and the pooled proportion requiring mechanical ventilation was 0.29 (95% CI: 0.14-0.50; I² = 81.4%; k = 5). When stratified by timepoint, the short-term estimate (k = 4) was 2.67 (95% CI: -0.05 to 5.39; I² = 86.1%), and only a single study contributed to the long-term stratum (SMD 1.20; 95% CI: 0.84-1.56), precluding pooling. Prediction intervals crossed the null in every analysis.
Early clinical and electrodiagnostic markers are consistently associated with functional outcomes in GBS across geographically diverse cohorts. However, the pooled estimates are exploratory and hypothesis-generating rather than generalizable: they rest on five small studies, exhibit very high heterogeneity, and are not robust to stratification by outcome timepoint. The direction of association should inform structured prognostic frameworks, and confirmatory prospective studies with standardized timepoints are required before pooled estimates can guide individual patient management.

PMID:
42927731
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.

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