{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:24:26Z","timestamp":1793384666594,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2019,7,15]],"date-time":"2019-07-15T00:00:00Z","timestamp":1563148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Myasthenia gravis (MG) and Guillain\u2013Barr\u00e9 Syndrome (GBS) are autoimmune neuromuscular disorders that may present as neuromuscular emergencies requiring mechanical ventilation and critical care. Comparative outcomes of these disease processes, once severe enough to require mechanical ventilation, are not known. In this study, we compared the patients requiring mechanical ventilation in terms of in-hospital complications, length of stay, disability, and mortality between these two disease entities at a national level. Materials and Methods: Mechanically ventilated patients with primary diagnosis of MG (n = 6684) and GBS (n = 5834) were identified through retrospective analysis of Nationwide Inpatient Sample (NIS) database for the years 2006 to 2014. Results: Even though mechanically ventilated MG patients were older (61.0 \u00b1 19.1 versus 54.9 \u00b1 20.1 years) and presented with more medical comorbidities, they had lower disease severity on admission, as well as lower in-hospital complications sepsis, pneumonia, and urinary tract infections as compared with GBS patients. In the multivariate analysis, after adjusting for confounders including treatment, GBS patients had significantly higher disability (odds ratio (OR) 15.6, 95% confidence interval (CI) 10.9\u201322.2) and a longer length of stay (OR 3.48, 95% CI 2.22\u20135.48). There was no significant difference in mortality between the groups (8.45% MG vs. 10.0% GBS, p = 0.16). Conclusion: Mechanically ventilated GBS patients have higher disease severity at admission along with more in-hospital complications, length of stay, and disability compared with MG patients. Potential explanations for these findings include delay in the diagnosis, poor response to immunotherapy particularly in patients with axonal GBS variant, or longer recovery time after nerve damage.<\/jats:p>","DOI":"10.3390\/medicina55070375","type":"journal-article","created":{"date-parts":[[2019,7,16]],"date-time":"2019-07-16T02:23:16Z","timestamp":1563243796000},"page":"375","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain\u2013Barr\u00e9 Syndrome"],"prefix":"10.3390","volume":"55","author":[{"given":"Anantha R.","family":"Vellipuram","sequence":"first","affiliation":[{"name":"Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Cruz-Flores","sequence":"additional","affiliation":[{"name":"Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Rauf A.","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4361-8498","authenticated-orcid":false,"given":"Prashanth","family":"Rawla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospitalist Sovah Health, Martinsville, VA 24112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Maud","sequence":"additional","affiliation":[{"name":"Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo J.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darine","family":"Kassar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paisith","family":"Piriyawat","sequence":"additional","affiliation":[{"name":"Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohtashim A.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1159\/000279334","article-title":"The incidence of myasthenia gravis: A systematic literature review","volume":"34","author":"McGrogan","year":"2010","journal-title":"Neuroepidemiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"123","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":"ref_3","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1177\/1941875210382918","article-title":"Myasthenic crisis","volume":"1","author":"Wendell","year":"2011","journal-title":"Neurohospitalist"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1097\/00003246-199707000-00027","article-title":"Therapy of myasthenic crisis","volume":"25","author":"Berrouschot","year":"1997","journal-title":"Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1001\/archneur.62.8.1194","article-title":"Supportive care for patients with Guillain-Barre syndrome","volume":"62","author":"Hughes","year":"2005","journal-title":"Arch. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1056\/NEJMra1114525","article-title":"Guillain-Barre syndrome","volume":"366","author":"Yuki","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1002\/ana.22139","article-title":"Comparative analysis of therapeutic options used for myasthenia gravis","volume":"68","author":"Mandawat","year":"2010","journal-title":"Ann. Neurol."},{"key":"ref_8","unstructured":"HCUP (2018). NIS Description of Data Elements."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1001\/archneur.56.1.25","article-title":"Late-onset myasthenia gravis: A changing scene","volume":"56","author":"Aarli","year":"1999","journal-title":"Arch. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1212\/01.WNL.0000050461.05432.C5","article-title":"Myasthenia gravis: A higher than expected incidence in the elderly","volume":"60","author":"Aragones","year":"2003","journal-title":"Neurology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1212\/WNL.54.5.1202","article-title":"Equal male and female incidence of myasthenia gravis","volume":"54","author":"Poulas","year":"2000","journal-title":"Neurology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1093\/brain\/awm004","article-title":"Immunotherapy for Guillain-Barre syndrome: A systematic review","volume":"130","author":"Hughes","year":"2007","journal-title":"Brain"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.nurt.2008.08.011","article-title":"Current and future standards in treatment of myasthenia gravis","volume":"5","author":"Gold","year":"2008","journal-title":"Neurotherapeutics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1126\/science.291.5503.484","article-title":"Anti-inflammatory activity of IVIG mediated through the inhibitory Fc receptor","volume":"291","author":"Samuelsson","year":"2001","journal-title":"Science"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s11910-010-0151-1","article-title":"Treatment of myasthenia gravis","volume":"11","author":"Kumar","year":"2011","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1212\/WNL.61.6.736","article-title":"Practice parameter: Immunotherapy for Guillain\u2013Barr\u00e9 syndrome: Report of the Quality Standards Subcommittee of the American Academy of Neurology","volume":"61","author":"Hughes","year":"2003","journal-title":"Neurology"},{"key":"ref_17","first-page":"9","article-title":"Intravenous immunoglobulin for Guillain-Barre syndrome","volume":"19","author":"Hughes","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1136\/jnnp.64.1.78","article-title":"Mortality and survival in myasthenia gravis: A Danish population based study","volume":"64","author":"Christensen","year":"1998","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1111\/j.1749-6632.1981.tb33765.x","article-title":"Aspects of the natural history of myasthenia gravis: Crisis and death","volume":"377","author":"Cohen","year":"1981","journal-title":"Ann. N.Y. Acad. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1136\/jnnp.45.3.217","article-title":"Ventilatory failure in myasthenia gravis","volume":"45","author":"Ferguson","year":"1982","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_21","first-page":"351","article-title":"Treatment of the critically ill patient with myasthenia gravis","volume":"3","author":"Fink","year":"1993","journal-title":"Neurol. Neurosurg. Intensive Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1111\/j.1749-6632.1987.tb51317.x","article-title":"The course of myasthenia gravis and therapies affecting outcomea","volume":"505","author":"Grob","year":"1987","journal-title":"Ann. N.Y. Acad. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1212\/WNL.88.16_supplement.P5.137","article-title":"Guillain-Barr\u00e9 Syndrome Trend of Hospital Length of Stay, Complication Rate and Mortality Depending from Method of the Treatment: IVIg vs. PLEX (P5. 137)","volume":"88","author":"Gevorgyan","year":"2017","journal-title":"Neurology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1111\/cei.12217","article-title":"Myasthenia gravis: An update for the clinician","volume":"175","author":"Sieb","year":"2014","journal-title":"Clin. Exp. Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"209","DOI":"10.59566\/IJBS.2009.5209","article-title":"Trends in Outcomes and Hospitalization Charges among Mechanically Ventilated Patients with Myasthenia Gravis in the United States","volume":"5","author":"Souayah","year":"2009","journal-title":"Int. J. Biomed. Sci. IJBS"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S1474-4422(07)70130-8","article-title":"A clinical prognostic scoring system for Guillain-Barr\u00e9 syndrome","volume":"6","author":"Steyerberg","year":"2007","journal-title":"Lancet Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1212\/WNL.0b013e3182104407","article-title":"Early recognition of poor prognosis in Guillain-Barre syndrome","volume":"76","author":"Walgaard","year":"2011","journal-title":"Neurology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1038\/nrneurol.2014.121","article-title":"Guillain\u2013Barr\u00e9 syndrome: Pathogenesis, diagnosis, treatment and prognosis","volume":"10","author":"Walgaard","year":"2014","journal-title":"Nat. Rev. Neurol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1016\/j.clinph.2012.01.025","article-title":"Electrodiagnostic criteria for Guillain\u2013Barr\u00e9 syndrome: A critical revision and the need for an update","volume":"123","author":"Uncini","year":"2012","journal-title":"Clin. Neurophysiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1002\/ana.410440512","article-title":"Electrophysiological classification of Guillain-Barr\u00e9 syndrome: Clinical associations and outcome","volume":"44","author":"Hadden","year":"1998","journal-title":"Ann. Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"444","DOI":"10.5694\/j.1326-5377.1985.tb113445.x","article-title":"Prevention of pulmonary complications in severe Guillain-Barr\u00e9 syndrome by early assisted ventilation","volume":"142","year":"1985","journal-title":"Med. J. Aust."},{"key":"ref_32","first-page":"638","article-title":"Risk Factors for Early-onset, Ventilator-associated Pneumonia in Critical Care PatientsSelected Multiresistantversus Nonresistant Bacteria","volume":"93","author":"Koltka","year":"2000","journal-title":"Anesthesiol. J. Am. Soc. Anesthesiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-Su\u00e1rez, I., Sanz-Gallego, I., de Rivera, F.J.R., and Arpa, J. (2013). Guillain-Barr\u00e9 syndrome: Natural history and prognostic factors: A retrospective review of 106 cases. BMC Neurol., 13.","DOI":"10.1186\/1471-2377-13-95"},{"key":"ref_34","first-page":"705","article-title":"Respiratory dysfunction in Guillain-Barr\u00e9 syndrome","volume":"15","author":"Orlikowski","year":"1994","journal-title":"Neurocrit. Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1212\/01.WNL.0000035640.84053.5B","article-title":"The morbidity of Guillain-Barr\u00e9 syndrome admitted to the intensive care unit","volume":"60","author":"Henderson","year":"2003","journal-title":"Neurology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1007\/s00134-006-0332-1","article-title":"Prognosis and risk factors of early onset pneumonia in ventilated patients with Guillain\u2013Barr\u00e9 syndrome","volume":"32","author":"Orlikowski","year":"2006","journal-title":"Intensive Care Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.3174\/ajnr.A3059","article-title":"Subarachnoid hemorrhage incidence in the United States does not vary with season or temperature","volume":"33","author":"McDonald","year":"2012","journal-title":"Am. J. Neuroradiol."},{"key":"ref_38","first-page":"10","article-title":"Evaluation of coding data quality of the HCUP National Inpatient Sample","volume":"21","author":"Berthelsen","year":"2000","journal-title":"Top. Health Inf. Manag."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/7\/375\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:05:53Z","timestamp":1760187953000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/7\/375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,15]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,7]]}},"alternative-id":["medicina55070375"],"URL":"https:\/\/doi.org\/10.3390\/medicina55070375","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,15]]}}}