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February 2017

Is Serum Albumin Associated With Guillain-Barré Syndrome Outcomes?

Author Affiliations
  • 1Institute of Neurology, University College London, London, England
JAMA Neurol. 2017;74(2):151-153. doi:10.1001/jamaneurol.2016.4625

Albumen makes its appearance in fluids during disease which do not contain it in health, and the quantity contained in the blood is frequently modified; its properties, therefore, require to be well understood by practitioners.1(p 228)

Henry Ancell

The incidence of Guillain-Barré syndrome (GBS) will increase after the spread of Zika virus across the world,2 and we need to be alert for research to help us manage the disease. The article by Fokkink et al3 in this issue of JAMA Neurology from the world-leading Rotterdam group reveals that a simple measurement of serum albumin concentration was associated with outcome in a cohort of 174 Dutch patients who had participated in randomized clinical trials. Before treatment with intravenous immunoglobulin, only 13% had hypoalbuminemia (albumin <3.5 g/dL [to convert to grams per liter, multiply by 10]). When the patients were divided into tertiles according to their pretreatment albumin concentrations, there was a significant association between low albumin and requirement for mechanical ventilation and severity of weakness at nadir. Although a low pretreatment albumin concentration was slightly associated with a slower recovery (eFigure 1 from the article by Fokkink et al3), this finding was not significant. After 2 weeks, the serum albumin concentrations had decreased, 35% were hypoalbuminemic, and the correlations with disease severity were stronger. By this time there was also a strong correlation between serum albumin concentration and subsequent delayed recovery as judged by Kaplan-Meier curves of the time to walk unaided (P = .001). Approximately 90% of those with normal serum albumin concentrations could walk unaided after 6 months compared with approximately 65% of those with hypoalbuminemia. The authors are the first to admit that their observations require validation in a new cohort of patients, and we can expect that this will emerge from the ongoing International Guillain-Barré Syndrome Outcome Study, which aims to collect information from 1500 patients of whom more than 1300 have already provided information.4 If confirmed, this observation will provide an easily measured biomarker to add to the clinical factors from which the Dutch have already derived helpful prognostic algorithms. Older age, preceding diarrheal illness, and greater weakness were associated with worse outcome in one study.5 Time from onset of weakness to admission, greater weakness, and presence of facial or bulbar weakness were associated with the need for mechanical ventilation in another.6 It remains to be seen whether addition of serum albumin concentration will make these algorithms more precise.

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