{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:14:38Z","timestamp":1778130878187,"version":"3.51.4"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Guillain-Barr\u00e9 syndrome (GBS) constitutes an immune-mediated inflammatory polyradiculoneuropathy. Stroke may coexist with GBS during the same clinical episode, but the associated clinical predictors remain insufficiently characterized. The present investigation therefore sought to construct a machine learning-based model for identifying concomitant stroke in patients with GBS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 260 patients with GBS who received care at the Second Affiliated Hospital of Army Medical University from January 1, 2015, to December 31, 2024. All candidate predictors were collected at admission. Feature selection was conducted using LASSO regression, and seven machine learning algorithms were developed and compared. An independent external validation cohort of 60 patients was obtained from the First Affiliated Hospital during the same period. Patients were subsequently grouped according to model-estimated probabilities, and short-term functional outcomes were compared between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine clinical predictors were selected to construct seven machine learning models. The neural network architecture exhibited the best performance for identifying concomitant stroke. Internal validation yielded an AUROC of 0.838 (95% CI: 0.739\u20130.923) for the optimal model. Sensitivity analysis excluding patients with documented prior stroke showed comparable performance. For all outcome measures, time displayed a substantial primary impact (p &amp;lt; 0.001), while interactive terms stayed statistically non-significant (p &amp;gt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The ANN model showed good performance for admission-time identification of concomitant stroke in patients with GBS and distinguished clinically different functional profiles among model-defined groups. Notably, while the longitudinal interaction between temporal factors and assigned risk strata did not achieve statistical significance, the stratification methodology successfully discerned clinically distinct outcome profiles in GBS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1790415","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:54:49Z","timestamp":1778129689000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Machine learning-based identification of concomitant stroke and prognostic analysis in patients with Guillain-Barr\u00e9 syndrome: a retrospective study"],"prefix":"10.3389","volume":"17","author":[{"given":"Yue","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Neurology, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuxin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Neurology, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lingxu","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongsheng","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Neurology, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Neurology, First Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaoyou","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Neurology, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00517-1","article-title":"Guillain-barr\u00e9 syndrome","volume":"397","author":"Shahrizaila","year":"2021","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1159\/000324710","article-title":"Population incidence of Guillain-Barr\u00e9 syndrome: a systematic review and meta-analysis","volume":"36","author":"Sejvar","year":"2011","journal-title":"Neuroepidemiology"},{"key":"B3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/pl00007844","article-title":"Distinct pattern of age-specific incidence of Guillain-Barr\u00e9 syndrome in Harbin, China","volume":"249","author":"Cheng","year":"2002","journal-title":"J Neurol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awy232","article-title":"Regional variation of Guillain-Barr\u00e9 syndrome","volume":"141","author":"Doets","year":"2018","journal-title":"Brain"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2020-209607","article-title":"Characteristics of patients who had a stroke not initially identified during emergency prehospital assessment: a systematic review","volume":"38","author":"Jones","year":"2021","journal-title":"Emerg Med J"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1161\/circresaha.121.319994","article-title":"Immune pathways in etiology, acute phase, and chronic sequelae of ischemic stroke","volume":"130","author":"Endres","year":"2022","journal-title":"Circ Res"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.525699","article-title":"Case report: Early-onset Guillain-Barre syndrome mimicking stroke","volume":"12","author":"Sun","year":"2021","journal-title":"Front Neurol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1159\/000450603","article-title":"Guillain-Barr\u00e9 syndrome and cerebral hemorrhage: two cases and literature review","volume":"76","author":"Wu","year":"2016","journal-title":"Eur Neurol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2024.02.107","article-title":"Guillain-Barr\u00e9 syndrome characterized by cerebral infarction: a case report with literature review","volume":"47","author":"Wang","year":"2024","journal-title":"Asian J Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1111\/cns.13569","article-title":"Peripheral inflammation and blood-brain barrier disruption: effects and mechanisms","volume":"27","author":"Huang","year":"2021","journal-title":"CNS Neurosci Ther"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-023-01282-2","article-title":"Neuroinflammation in acute ischemic and hemorrhagic stroke","volume":"23","author":"Alsbrook","year":"2023","journal-title":"Curr Neurol Neurosci Rep"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12822","article-title":"eDoctor: machine learning and the future of medicine","volume":"284","author":"Handelman","year":"2018","journal-title":"J Intern Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1038\/s41580-021-00407-0","article-title":"A guide to machine learning for biologists","volume":"23","author":"Greener","year":"2022","journal-title":"Nat Rev Mol Cell Biol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"I","DOI":"10.1177\/23969873221100032","article-title":"European Stroke Organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack","volume":"7","author":"Dawson","year":"2022","journal-title":"Eur Stroke J"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1161\/str.0000000000000475","article-title":"2024 guideline for the primary prevention of stroke: a guideline from the American Heart Association\/American Stroke Association","volume":"55","author":"Bushnell","year":"2024","journal-title":"Stroke"},{"key":"B17","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1177\/23969873231219416","article-title":"European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke","volume":"9","author":"Wardlaw","year":"2024","journal-title":"Eur Stroke J"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1161\/str.0b013e318296aeca","article-title":"An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"44","author":"Sacco","year":"2013","journal-title":"Stroke"},{"key":"B19","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1358\/dot.1998.34.7.485264","article-title":"Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment","volume":"24","author":"Adams","year":"1993","journal-title":"Stroke"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-019-0250-9","article-title":"Diagnosis and management of Guillain-Barr\u00e9 syndrome in ten steps","volume":"15","author":"Leonhard","year":"2019","journal-title":"Nat Rev Neurol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(03)15324-x","article-title":"Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barr\u00e9 syndrome: randomised trial","volume":"363","author":"van Koningsveld","year":"2004","journal-title":"Lancet"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24207","article-title":"INCAT disability score: a critical analysis of its measurement properties","volume":"50","author":"Breiner","year":"2014","journal-title":"Muscle Nerve"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0b013e318208824b","article-title":"Rasch-built Overall Disability Scale (R-ODS) for immune-mediated peripheral neuropathies","volume":"76","author":"van Nes","year":"2011","journal-title":"Neurology"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880141111","article-title":"Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barr\u00e9 syndrome","volume":"14","author":"Kleyweg","year":"1991","journal-title":"Muscle Nerve"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwk052","article-title":"Relaxing the rule of ten events per variable in logistic and Cox regression","volume":"165","author":"Vittinghoff","year":"2007","journal-title":"Am J Epidemiol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1177\/0962280218784726","article-title":"Sample size for binary logistic prediction models: Beyond events per variable criteria","volume":"28","author":"van Smeden","year":"2019","journal-title":"Stat Methods Med Res"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s41664-018-0068-2","article-title":"On splitting training and validation set: a comparative study of cross-validation, bootstrap and systematic sampling for estimating the generalization performance of supervised learning","volume":"2","author":"Xu","year":"2018","journal-title":"J Anal Test"},{"key":"B28","doi-asserted-by":"publisher","first-page":"jkab032","DOI":"10.1093\/g3journal\/jkab032","article-title":"Heuristic hyperparameter optimization of deep learning models for genomic prediction","volume":"11","author":"Han","year":"2021","journal-title":"G3 (Bethesda)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1038\/s42256-019-0138-9","article-title":"From local explanations to global understanding with explainable AI for trees","volume":"2","author":"Lundberg","year":"2020","journal-title":"Nat Mach Intell"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2233","DOI":"10.3390\/jcm9072233","article-title":"Age-related risk factors at the first stroke event","volume":"9","author":"Soto-C\u00e1mara","year":"2020","journal-title":"J Clin Med"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1007\/s00424-020-02508-9","article-title":"Vascular and haemodynamic issues of brain ageing","volume":"473","author":"Beishon","year":"2021","journal-title":"Pflugers Arch"},{"key":"B32","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1038\/s41569-020-0431-7","article-title":"Ageing and atherosclerosis: vascular intrinsic and extrinsic factors and potential role of IL-6","volume":"18","author":"Tyrrell","year":"2021","journal-title":"Nat Rev Cardiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2909","DOI":"10.3390\/ijms24032909","article-title":"Endothelial dysfunction in neurodegenerative diseases","volume":"24","author":"Fang","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B34","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1136\/svn-2020-000422","article-title":"Associations of blood biomarkers with glomerular filtration rate in patients with TIA and stroke: population-based study","volume":"6","author":"Kelly","year":"2021","journal-title":"Stroke Vasc Neurol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-physiol-060821-014521","article-title":"Cerebral vascular dysfunctions detected in human small vessel disease and implications for preclinical studies","volume":"84","author":"Wardlaw","year":"2022","journal-title":"Annu Rev Physiol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"10628","DOI":"10.3390\/ijms251910628","article-title":"Metabolic syndrome, thyroid dysfunction, and cardiovascular risk: the triptych of evil","volume":"25","author":"Pingitore","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3389\/fcell.2020.614030","article-title":"Thyroid hormones interaction with immune response, inflammation and non-thyroidal illness syndrome","volume":"8","author":"De Luca","year":"2020","journal-title":"Front Cell Dev Biol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.70818","article-title":"Association between thyroid hormone levels and disease prognosis in Guillain-Barr\u00e9 syndrome: a retrospective study","volume":"8","author":"Huang","year":"2025","journal-title":"Health Sci Rep"},{"key":"B39","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1161\/hypertensionaha.123.19943","article-title":"Cerebral small vessel disease, hypertension, and vascular contributions to cognitive impairment and dementia","volume":"81","author":"Hainsworth","year":"2024","journal-title":"Hypertension"},{"key":"B40","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1186\/s12883-025-04264-8","article-title":"A four-year assessment of demographic information, clinical presentations, risk factors and outcomes in lacunar stroke patients","volume":"25","author":"Rahnemayan","year":"2025","journal-title":"BMC Neurol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.798958","article-title":"Endothelial dysfunction in hypertension: current concepts and clinical implications","volume":"8","author":"Gallo","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.12101","article-title":"Frequency of autonomic dysfunction in patients of Guillain Barre syndrome in a tertiary care hospital","volume":"12","author":"Singh","year":"2020","journal-title":"Cureus"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.3390\/antiox10081306","article-title":"Pathophysiological association between diabetes mellitus and endothelial dysfunction","volume":"10","author":"Maruhashi","year":"2021","journal-title":"Antioxidants (Basel)"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.03.335","article-title":"Glycated hemoglobin and subclinical atherosclerosis in people without diabetes","volume":"77","author":"Rossello","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/5245308","article-title":"Mechanistic insights into the oxidized low-density lipoprotein-induced atherosclerosis","volume":"2020","author":"Khatana","year":"2020","journal-title":"Oxid Med Cell Longev"},{"key":"B46","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s12872-022-02491-2","article-title":"Hyperlipidemia and hypertension have synergistic interaction on ischemic stroke: insights from a general population survey in China","volume":"22","author":"Wang","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"B47","doi-asserted-by":"publisher","first-page":"17103","DOI":"10.1093\/med\/9780198845096.003.0015","article-title":"Antiphospholipid syndrome","volume":"4","author":"Schreiber","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"B48","doi-asserted-by":"publisher","first-page":"4812","DOI":"10.3390\/jcm14144812","article-title":"Lupus anticoagulant testing for diagnosis of antiphospholipid syndrome: a perspective informed by local practice","volume":"14","author":"Favaloro","year":"2025","journal-title":"J Clin Med"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.01018","article-title":"Differences in thyroid function and autoantibodies in the development of Guillain-Barr\u00e9 syndrome vs. chronic inflammatory demyelinating polyradiculoneuropathy","volume":"11","author":"Tu","year":"2020","journal-title":"Front Neurol"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.2147\/tcrm.s174961","article-title":"Hematocrit and the incidence of stroke: a prospective, population-based cohort study","volume":"14","author":"Yang","year":"2018","journal-title":"Ther Clin Risk Manag"},{"key":"B51","doi-asserted-by":"publisher","first-page":"875714","DOI":"10.5005\/jp\/books\/11339_21","article-title":"Influence of hyperglycaemia and CRP on the need for mechanical ventilation in Guillain-Barr\u00e9 syndrome","volume":"13","author":"\u0160t\u011btk\u00e1\u0159ov\u00e1","year":"2022","journal-title":"Front Neurol"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.4103\/1673-5374.317959","article-title":"Hyperglycemia in acute ischemic stroke: physiopathological and therapeutic complexity","volume":"17","author":"Ferrari","year":"2022","journal-title":"Neural Regener Res"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-082505","article-title":"PROBAST+AI: an updated quality, risk of bias, and applicability assessment tool for prediction models using regression or artificial intelligence methods","volume":"388","author":"Moons","year":"2025","journal-title":"Bmj"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1790415\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:54:59Z","timestamp":1778129699000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1790415\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":53,"alternative-id":["10.3389\/fimmu.2026.1790415"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1790415","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]},"article-number":"1790415"}}