Prevalence, clinical characteristics and outcomes of Guillain-Barré syndrome spectrum associated with COVID-19: a systematic review and meta-analysis.

BACKGROUND Mounting evidence supports an association between Guillain-Barre syndrome spectrum (GBSs) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, GBSs in the setting of coronavirus disease-2019 (COVID-19) remains poorly characterized, while GBSs prevalence among COVID-19 patients has not been previously systematically evaluated using a meta-analytical approach. METHODS We performed a systematic review and meta-analysis of observational cohort and case-series studies reporting on the occurrence, clinical characteristics and outcomes of patients with COVID-19-associated GBSs. A random-effects model was used to calculate pooled estimates and odds ratios (ORs) with corresponding 95% confidence intervals (CIs), when comparing to non-COVID-19, contemporary or historical GBSs patients. RESULTS We identified 18 eligible studies (11 cohorts, 7 case-series) including a total of 136,746 COVID-19 patients. Among COVID-19 patients, including hospitalized and non-hospitalized cases, the pooled GBSs prevalence was 0.15‰ (95%CI:0-0.49‰; I2 =96%). Compared to non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds for demyelinating GBSs subtypes (OR=3.27; 95%CI: 1.32-8.09; I2 =0%). In SARS-CoV-2 infected patients, olfactory or concomitant cranial nerve involvement was noted in 41.4% (95%CI:3.5-60.4%; I2 =46%) and 42.8% (95%CI:32.8-53%; I2 =0%) of the patients, respectively. Clinical outcomes including in-hospital mortality were comparable between COVID-19 GBSs patients and non-infected contemporary or historical GBSs controls. CONCLUSIONS GBSs prevalence was estimated at 15 cases per 100,000 SARS-CoV-2 infections. COVID-19 appears to be associated with an increased likelihood of GBSs and with demyelinating GBSs variants in particular.