Post-COVID-19 surge in Guillain-Barré syndrome during the Omicron wave in China with clinical characteristics and potential immune-mediated pathways

This multicenter study investigated the epidemiological and clinical characteristics of Guillain-Barré syndrome (GBS) during China's Omicron wave (December 2022-February 2023), and compared the number of GBS hospitalizations with the historical data for the same period from 2018 to 2022. A retrospective analysis was conducted at two tertiary hospitals, categorizing patients into COVID-GBS (case group) and Non-COVID-GBS (control group). During the Omicron wave, the number of GBS hospitalizations was 1.5 times higher compared to the period of 2018-2019 (99 cases vs. 66 cases). Poisson regression analysis confirmed a significant increase in GBS incidence during the Omicron wave (December 2022-February 2023) compared to the 2018-2019 baseline period, with an IRR of 1.541 (95% CI: 1.123-2.129, p = 0.0079). COVID-19-associated GBS patients were significantly older (54.04 vs. 42.06 years, p = 0.002) and exhibited higher rates of cranial nerve involvement (p = 0.014), particularly bulbar involvement (p = 0.009). Acute severity was greater in COVID-19-associated cases, evidenced by elevated ICU admissions, higher peak GBS disability scores (p = 0.048), increased mechanical ventilation needs, and one fatality. The median latency from COVID-19 infection to neurological onset was 9.5 days (IQR: 8-14). Despite these acute differences, 6-month disability outcomes showed no significant divergence between groups, suggesting similar long-term prognoses. The surge in GBS incidence aligns with broader reports of elevated GBS rates during COVID-19 surges, though mechanistic links may involve immune-mediated pathways rather than direct viral causation.