Hematocrit is an independent risk factor of recurrent Guillain-Barré syndrome

Hematocrit is an independent risk factor of recurrent Guillain-Barré syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Hematocrit is an independent risk factor of recurrent Guillain-Barré syndrome Lijuan Wang, Yuelin Liu, Yaowei Ding, Siwen Li, Wencan Jiang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5330730/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Guillain-Barré Syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system, characterized by progressive weakness and diminished or absent myotatic reflexes. While GBS typically exhibits a monophasic course, recurrent episodes can occur in certain patients. This study aimed to explore potential risk factors associated with recurrent GBS. We conducted a retrospective analysis involving GBS patients admitted to Beijing Tiantan Hospital between January 2012 and January 2022. Patients were categorized into recurrent and non-recurrent groups based on follow-up outcomes, meanwhile, clinical and laboratory data were compared between the two cohorts. Then, we integrated statistically significant indicators to identify independent risk factors for recurrent GBS using multifactorial logistic regression. Univariate analysis revealed that hematocrit (HCT) and mean platelet volume (MPV) were significantly elevated, whereas free triiodothyronine (FT3) and the percentage of vaccination was lower in patients with recurrent GBS compared to non-recurrent groups. Multifactorial logistic regression analysis revealed HCT (OR:1.015;95%CI: 1.001–1.028༛P = 0.032) is an independent risk factor for recurrent GBS. Elevated serum HCT levels correlate with an increased risk of recurrent GBS. Crucially, the incidence of recurrent GBS patients rises in tandem with rising serum HCT levels. Recurrent Guillain-Barré syndrome hematocrit Figures Figure 1 1. Introduction Guillain-Barré Syndrome (GBS) is an autoimmune-mediated inflammatory demyelinating disease affecting peripheral nerves and nerve roots. Approximately two-thirds of patients have a preceding infection. Clinically, it presents with various symptoms such as rapidly progressing limb weakness, decreased tendon reflexes, and reduced muscle tone [ 1 ]. The incidence of GBS has been increasing in recent years, making it one of the most common causes of acute delayed paralysis [ 2 ]. It is generally considered to be a monophasic disease, yet some patients experience relapses after long periods of remission. The incidence of recurrent GBS has been estimated at approximately 2–6.8% [ 3 ]. Recurrent GBS is marked by recurrent episodes and remission phases with similar clinical manifestations but without clear correlation between episodes. Patients often recover complete or nearly complete during the intervals between episodes. There have been limited investigations on recurrent GBS, primarily comprising special case reports. Recurrent GBS predominantly affected young males and different GBS subtypes were observed to recur [ 4 ]. Previous respiratory and gastrointestinal infections have been associated with recurrent GBS [ 5 ]. Elevated serum levels of thyroid stimulating hormone (TSH) independently increase the risk of recurrent GBS [ 6 ]. A long-term population-based study suggested that recurrent GBS tends to have a shorter duration compared to monophasic GBS. However, no additional immunologic susceptibility factors contributing to relapses beyond those previously identified have been definitively established, and there is no discernible trend towards a significant reduction in recurrence rates [ 7 ]. Recurrent GBS typically presents with a sudden onset, characterized by irregularity and unpredictable recurrence [ 8 ]. There are limited and contentious studies on assessing risk factors for recurrent GBS. Hence, it is essential to investigate the factors contributing to recurrent GBS and ensure timely intervention and treatment for patients. 2. Methods 2.1 Subjects All patients with GBS [ 9 ] were retrospectively recruited at Beijing Tiantan Hospital, Capital Medical University from January 2012 to January 2022. The protocol was approved by the Ethics Committee of Beijing Tiantan Hospital (batch number: KY-2022-039-01) and performed in accordance with the Helsinki Declaration of Human Studies. Informed consent was obtained from all subjects and/or their legal guardian(s). A total of 297 GBS patients were included in this study, Based on the follow-up, 29 cases of lost visits and deaths were excluded, and finally 268 patients were enrolled in the study. 2.2 Data collection Clinical information of 268 patients with GBS included in the study was collected from the Hospital Information Management System (HIS) of Beijing Tiantan Hospital affiliated with Capital Medical University. This dataset encompassed fundamental demographics such as sex and age, as well as medical history including cigarette smoking, alcohol consumption, systolic blood pressure (SBP), diastolic blood pressure (DBP), hypertension, diabetes mellitus, heart diseases, trauma, surgery, body mass index (BMI), vaccination and preceding infections. Laboratory data of 268 GBS patients were queried from the Laboratory Information Management System (LIS) of Beijing Tiantan Hospital affiliated with Capital Medical University. Laboratory data include white blood cell (WBC), lymphocyte (LY), monocyte (MO), neutrophil (NEUT), hematocrit (HCT), platelet (PLT), platelet volume distribution width (PDW), mean platelet volume (MPV), glucose (GLU), triglyceride (TG), cholesterol (CHO), high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein A1(APOA1), apolipoprotein B (APOB), residual cholesterol (RC), dyslipidemia index, triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4). Dyslipidemia was defined as at least one abnormality in CHO, TG, HDL, LDL, APOA1 or APOB [ 10 ], and the dyslipidemia index was defined as the number of abnormalities for each of the six indicators. 2.3 Statistical analysis SPSS software (version 20.0) was used for statistical analysis. The Normally distributed continuous variables were compared using the Student’s t-test, whereas non-normally distributed data were assessed using the Mann-Whitney U test. We performed a multifactorial logistic regression analysis to explore the independent risk factors for recurrent GBS. The Spearman rank correlation coefficient and Mantel–Haenszel test were performed to analyze the correlation between clinical and laboratory characteristics and risk factor quartile. A p-value less than 0.05 were considered statistically significant. 3. Results 3.1 Comparison of clinical characteristics in recurrent and non-recurrent patients with GBS A total of 297 patients with GBS were initially enrolled in this study. After follow-up, 29 cases of lost follow-ups and deaths were excluded, resulting in a final cohort of 268 patients, including 132 cases in recurrent group and 136 cases in non-recurrent group. The clinical characteristics of the recurrent GBS patients and univariate factors associated with the risk of recurrent GBS are presented in Table 1 . The percentage of vaccination was lower in recurrent group than non-recurrent group, and there was no statistically significant difference between the two groups such as sex, age, cigarette smoking, alcohol consumption, SBP, DBP, hypertension, diabetes mellitus, heart disease, trauma, surgery, BMI and preceding infection. Table 1 Clinical characteristics in patients with Recurrent GBS and Non-Recurrent GBS Characteristics Recurrent GBS Non-Recurrent GBS P N = 132 N = 136 Sex, male, n (%) 70(53%) 83(61%) 0.187 Age, y 53 (36, 62) 47 (32.5, 58.5) 0.059 Cigarette smoking 42(32%) 43(32%) 0.895 Alcohol consumption 38(29%) 47(35%) 0.233 SBP, mmHg 133 (124, 143) 133.5 (120, 144) 0.607 DBP, mmHg 83 (75, 91) 82.5 (78, 90) 0.548 Hypertension 34(26%) 26(19%) 0.303 Diabetes mellitus 12(10%) 14(10%) 0.684 Heart disease 5(4%) 3(2%) 0.722 Trauma 11(8%) 11(8%) 1.000 Surgery 23(17.4%) 31(23%) 0.222 BMI, kg/m 2 24.22 (21.7, 26.64) 24.34 (22, 26.89) 0.750 Vaccination 2(2%) 15(11%) 0.002 Preceding infection 64(49%) 57(42%) 0.456 Data presented as mean ± SD, median (Q1-Q3) or percentage. Abbreviations: DBP, Diastolic blood pressure; SBP, Systolic blood pressure; BMI, Body mass index. 3.2 Univariate analysis of laboratory indicators in recurrent and non-recurrent groups A univariate analysis was performed on 132 patients with recurrent GBS and 136 patients with non-recurrent GBS for laboratory indicators. The laboratory characteristics of the recurrent GBS patients and univariate factors associated with the risk of recurrent GBS are presented in Table 2 . The results showed that the levels of HCT and MPV were significantly higher in recurrent group than non-recurrent group, whereas FT3 were lower in recurrent group. The rest of the indices such as WBC, LY, MO, NEUT, PLT, PDW, GLU, TG, CHO, HDL, LDL, APOA1, APOB, RC, dyslipidemia index, T3, T4, TSH, and FT4 were not statistically different. Table 2 Laboratory characteristics in patients with Recurrent GBS and Non-Recurrent GBS Characteristics Recurrent GBS Non-Recurrent GBS P Value N = 132 N = 136 WBC 6.91 (5.66, 8.94) 6.84 (5.91, 8.89) 0.798 LY 1.71 (1.31, 2.07) 1.69 (1.25, 2.23) 0.674 MO 0.45 (0.34, 0.57) 0.44 (0.36, 0.56) 0.567 NEUT 4.64 (3.21, 6.58) 4.50 (3.47, 6.27) 0.776 HCT 38.9 (0.47, 42.75) 16.05 (0.4, 41.35) 0.004 PLT 237.5 (194.25, 279.5) 245.5 (207.25, 292.75) 0.275 PDW 14.8 (11.4, 16.1) 15.7 (12.68, 16.10) 0.072 MPV 10.15 (9.50, 10.80) 9.8 (9.28, 10.60) 0.022 GLU 4.90 (4.33, 5.84) 4.71 (4.33, 5.36) 0.297 TG 1.24 (0.83, 1.96) 1.32 (0.96, 1.82) 0.253 CHO 4.07 ± 0.84 4.02 ± 0.77 0.656 HDL 1.06 (0.88, 1.24) 1.09 (0.96, 1.31) 0.187 LDL 2.45 (1.95, 3.13) 2.39 (1.89, 2.92) 0.512 APO-A1 1.16 ± 0.24 1.19 ± 0.23 0.339 APO-B 0.86 ± 0. 22 0.83 ± 0.19 0.125 RC 0.47 (0.37, 0.62) 0.47 (0.34, 0.61) 0.557 Dyslipidemia index 0.456 0 1 2 ≥ 3 29 (22%) 28(21.2%) 37 (28%) 35 (26.5%) 25 (18.4%) 38 (27.9%) 35 (25.7%) 28 (20.6%) T3 1.30 (1.05, 1.52) 1.33 (1.01, 1.54) 0.993 T4 102.03 (83.27, 121.85) 107.28 (91.51, 128.19) 0.134 TSH 1.54 (0.90, 2.38) 1.57 (0.86, 2.27) 0.648 FT3 4.24 (3.65, 4.74) 4.42 (3.86, 4.98) 0.037 FT4 13.33 (11.98, 15.07) 13.53 (12.01, 14.77) 0.820 WBC: white blood cell; LY: lymphocyte; MO: Monocyte; NEUT: neutrophil; HCT: Hematocrit; PLT: platelet; PDW: platelet volume distribution width; MPV: mean platelet volume; GLU: glucose; TG: triglyceride; CHO: cholesterol; HDL: high-density lipoprotein; LDL: low-density lipoprotein; APOA1: apolipoprotein A1; APOB: apolipoprotein B; RC: residual cholesterol; T3: triiodothyronine; T4: thyroxine; TSH: thyroid-stimulating hormone; FT3: free triiodothyronine; FT4: free thyroxine. 3.3 Potential risk factors for recurrent patients with GBS Vaccination, HCT, MPV and FT3 which were significantly different on univariate analysis and were included in multivariate logistic regression analysis. Multivariate logistic analysis revealed that HCT was an independent risk factor for the recurrence of GBS(OR:1.015;95%CI: 1.001–1.028༛P = 0.032). 3.4 Analysis of clinical characteristics and laboratory indicators of patients with recurrent GBS based on HCT quartiles The clinical and laboratory characteristics of recurrent GBS patients based on the HCT are shown in Table 3 . HCT quartiles were positively correlated with cigarette smoking, alcohol consumption, LDL, RC, dyslipidemia index, but exhibited a significant negative association with vaccination, T4 and PLR. Crucially, the proportion of recurrent GBS patients increased with the increase in the HCT (Fig. 1 ). Table 3 Clinical and Laboratory Characteristics of patients with recurrent GBS according to HCT Quartile Characteristics Q1 (42.45) P trend Patients 24 31 40 35 Sex (male) 6(25%) 14(45.2%) 23(57.5%) 27(77.1%) 0.707 Age, y 56.5 (32.75, 63) 55 (39, 64) 48.5 (35.75, 60) 53 (35.5, 60) 0.728 Cigarette smoking 5(20.8%) 4(12.9%) 16(40%) 18(51.4%) 0.004 Alcohol consumption 3(12.5%) 4(12.9%) 13(32.5%) 19(70.4%) < 0.001 SBP, mmHg 134.12 ± 17.14 130.03 ± 21.35 133.25 ± 13.43 134.57 ± 17.39 0.727 DBP, mmHg 84 (75.75, 93) 83.5 (78.75, 90) 84.25 (74.75, 92) 78 (72.5, 88) 0.358 Hypertension 9(37.5%) 8(25.8%) 8(20%) 9(25.7%) 0.496 Diabetes mellitus 2(8.3%) 2(6.5%) 2(5%) 4(11.4%) 0.758 Heart disease 0(0%) 1(3.2%) 2(5%) 2(5.7%) 0.690 Trauma 2(8.3%) 2(13.3) 4(9.1) 3(10) 0.963 Surgery 7(20.8) 2(6.5%) 9(22.5%) 5(14.3%) 0.123 BMI, kg/m 2 23.88 (22.15, 26.67) 24.24 (20.96, 26.13) 23.62 (21.56, 25.87) 25.48 (23.7, 27.24) 0.113 Vaccination 2(8.3%) 0(0%) 0(0%) 0(0%) 0.033 Preceding infection 12(50%) 14(45.2%) 21(52.5%) 16(45.7%) 0.913 LDL 2.27 ± 0.72 2.33 ± 0.76 2.73 ± 0.93 2.74 ± 0.86 0.046 RC 0.405 (0.3, 0.51) 0.55 (0.43, 0.71) 0.49 (0.41, 0.62) 0.46 (0.33, 0.59) 0.046 Dyslipidemia index 0.018 0 4 (16.7%) 8 (25.8%) 10 (25%) 7 (20%) 1 11 (45.8%) 2 (6.5%) 10 (25%) 5(14.3%) 2 6 (25%) 13 (41.9% 7 (17.5%) 11 (31.4%) ≥ 3 2 (8.3%) 8 (25.8%) 13 (32.5%) 12 (34.3%) T4 121.08(104.98, 145.97) 111.19 (88.70, 122.95) 85.14 (78.66, 107.15) 100.67 (85.70, 108.27) 0.001 4. Discussions Patients with GBS frequently have a history of preceding infections before both initial and recurrent episodes. The interval between the appearance of the triggering event and the onset of the disease, as well as between disease onset and peak symptoms, tends to be shorter in recurrent cases compared to initial episodes. Additionally, recurrent cases often exhibit more severe symptoms and signs. The onset of recurrent GBS is abrupt, with symptoms reaching their peak quickly, and there is no significant regularity or predictability in recurrence, with cycles varying from a few months to several years [ 8 ]. Thus, it is of great importance to explore the risk factors for recurrent GBS. In this study, we explored the potential risk factors for recurrent GBS, taking clinical and laboratory factors into account. Our results revealed that HCT, MPV, FT3, and vaccination were significantly different in patients with recurrent GBS compared to those without recurrence. Multivariate logistic analysis revealed that HCT was an independent risk factor of recurrent GBS and increased HCT was correlated with a higher risk of recurrent GBS. There is limited research exploring the relationship between HCT levels and GBS. A.M. Richards [ 11 ] and colleagues reported a case where a GBS patient exhibited high blood pressure and elevated HCT, potentially due to a rapid increase in blood pressure causing a "stress triad," which results in plasma volume depletion and a concomitant rise in hematocrit. An elevated hematocrit was significant predictors of central nervous system, and elevated hematocrit was more prone to developing peripheral nervous system manifestations [ 12 ]. Further we analyzed the clinical and laboratory characteristics of recurrent GBS according to HCT quartiles. The findings indicated that HCT quartiles were positively correlated with both cigarette smoking and alcohol consumption. Additionally, prior research has identified cigarette smoking and alcohol use as potential independent risk factors for GBS [ 13 ]. Chronic alcohol intake can adversely affect both the central and peripheral nervous systems. Long-term alcohol consumption is primarily associated with sleep disturbances, chronic pain, cognitive and behavioral disorders, strokes, as well as damage to peripheral nerves and muscles. The mechanisms underlying alcoholic neuropathy remain debated, though it is largely linked to nutritional deficiencies and the neurotoxic effects of alcohol. Recent studies have proposed that alcohol consumption may cause axonal degeneration through oxidative stress, the release of pro-inflammatory cytokines, and the activation of protein kinase C [ 14 ]. Moreover, instances of GBS induced by alcohol have been documented [ 15 , 16 ]. The positive correlation observed between cigarette smoking and HCT quartiles may stem from smoking's role in elevating erythropoietin levels [ 17 , 18 ]. Nonetheless, the connections among HCT, cigarette smoking, and alcohol consumption, as well as their contributions to the pathogenesis of GBS and recurrent GBS, require further investigation. Our study demonstrated that levels of LDL, RC, and dyslipidemia indices significantly increased with higher HCT levels. Previous research has identified RC and dyslipidemia as independent risk factors for both GBS and severe GBS. Elevated RC levels and dyslipidemia indices were linked to a higher incidence of severe GBS and corresponded with increased GBS disability scores [ 13 ]. Notably, GBS patients experienced a significant decrease in total cholesterol (TC) following intravenous immunoglobulin therapy [ 19 ]. Some studies have established a connection between altered lipid metabolism and peripheral nerve dysfunction. Disruptions in cholesterol metabolism may compromise myelin integrity, which is targeted by the immune system in certain forms of GBS [ 20 ]. Additionally, LDL and serum TC levels have been associated with cognitive impairment in patients with multiple sclerosis (MS) [ 21 ]. In type 2 diabetes, dyslipidemia can adversely affect dorsal root ganglion neurons and induce mitochondrial dysfunction [ 22 ]. Furthermore, elevated levels of LDL cholesterol in midlife have been linked to an increased risk of Alzheimer’s disease in old age [ 23 ]. However, the interactions between HCT and lipid levels, as well as their roles in patients with recurrent GBS, remain unclear. Consistent with previous research, our findings revealed low levels of FT3 in patients with recurrent GBS. In contrast to earlier studies, we did not observe elevated TSH levels as an independent risk factor for recurrent GBS. However, we identified a negative correlation between T4 levels and HCT quartiles [ 6 ]. This discrepancy may be attributed to the sample size and the confounding effects inherent in multifactorial regression analysis. One study indicated that, compared to healthy controls, GBS patients exhibited lower TSH levels and higher FT4 and FT4/FT3 ratios, which were linked to the incidence and severity of GBS [ 24 ]. Additionally, some studies have suggested that thyroid hormone levels correlate with oxidative and antioxidant status. Recent research has demonstrated that increased reactive oxygen species (ROS) and an imbalance between malondialdehyde (MDA) and antioxidant activity in the plasma of GBS patients, compared to healthy individuals, may activate the mitogen-activated protein (MAP) kinase pathway in Schwann cells, leading to subsequent axonal damage [ 25 , 26 ]. A wide range of research have shown that the myelination process in patients with multiple sclerosis is influenced by thyroid hormones, which can enhance remyelination and mitigate demyelination by shifting the demyelination/remyelination balance in favor of remyelination and promoting the development of oligodendrocyte lineage cells [ 27 ]. These findings suggest a potential association between thyroid hormones and GBS. Nevertheless, the specific role of thyroid hormones in recurrent GBS and their relationship with HCT warrant further investigation at this time. Infection with the novel coronavirus (COVID-19), influenza, and various vaccinations may induce the onset or recurrence of GBS, although related research remains contentious [ 28 – 31 ]. In our study, we found that the percentage of vaccinated individuals experiencing recurrent GBS was significantly lower. Additionally, as HCT levels rose, the proportion of vaccinated patients with recurrent GBS also markedly diminished. This finding contradicts the established association between vaccinations and GBS noted in earlier studies, likely due to differences in sample sizes and the absence of specific vaccine type categorization. More research is essential to clarify the effects of vaccination on GBS and its recurrence. 5 Conclusions Hematocrit (HCT) is an independent risk factor for the recurrence of GBS. As HCT levels increase, the risk of GBS recurrence also rises, leading to a higher incidence of recurring cases. Declarations Data Availability The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. References Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016 Aug 13; 388(10045):717-27. Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet. 2021 Mar 27; 397(10280):1214-1228. Principi N, Esposito S. Vaccine-preventable diseases, vaccines and Guillain-Barre' syndrome. 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McDonnell EP, Altomare NJ, Parekh YH, Gowda RC, Parikh PD, Lazar MH, Blaser MJ. COVID-19 as a Trigger of Recurrent Guillain-Barré Syndrome. Pathogens. 2020 Nov 19;9(11):965. Shapiro Ben David S, Potasman I, Rahamim-Cohen D. Rate of Recurrent Guillain-Barré Syndrome After mRNA COVID-19 Vaccine BNT162b2. JAMA Neurol. 2021 Nov 1;78(11):1409-1411. Griffin G, Cunningham B, Beary JM, Spolter Y, Gandee R, Newey CR. Lighting Strikes Twice: Recurrent Guillain-Barré Syndrome (GBS) after Influenza Vaccination. Case Rep Neurol Med. 2021 Feb 3;2021:6690643. Miletic Drakulic SD, Lazarevic SR, Miloradovic IP, Jankovic VS. Reccurent guillain barré syndrome after COVID-19. Neurosciences (Riyadh). 2023 Oct;28(4):273-276. doi: 10.17712/nsj.2023.4.20230012. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5330730","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":376328187,"identity":"1b033d6a-3643-4006-9c9b-5440c4737418","order_by":0,"name":"Lijuan Wang","email":"","orcid":"","institution":"Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lijuan","middleName":"","lastName":"Wang","suffix":""},{"id":376328188,"identity":"de9abfa5-3340-4534-aa87-ab5ba35fe33b","order_by":1,"name":"Yuelin Liu","email":"","orcid":"","institution":"Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuelin","middleName":"","lastName":"Liu","suffix":""},{"id":376328189,"identity":"3f24cbc6-70d5-4a67-8761-22d89b5dfa55","order_by":2,"name":"Yaowei Ding","email":"","orcid":"","institution":"Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yaowei","middleName":"","lastName":"Ding","suffix":""},{"id":376328190,"identity":"88061a62-4710-4ae7-8b9b-1034014c0c66","order_by":3,"name":"Siwen Li","email":"","orcid":"","institution":"Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Siwen","middleName":"","lastName":"Li","suffix":""},{"id":376328191,"identity":"ed3faf33-f3bf-471e-8e95-27e1d7c6bffa","order_by":4,"name":"Wencan Jiang","email":"","orcid":"","institution":"Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wencan","middleName":"","lastName":"Jiang","suffix":""},{"id":376328192,"identity":"7d1a6e1c-cc8f-400d-a2f5-8b989cceeb27","order_by":5,"name":"Xiang Li","email":"","orcid":"","institution":"Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiang","middleName":"","lastName":"Li","suffix":""},{"id":376328193,"identity":"39c57533-34ab-4d1b-8edb-f8cf2f287ab9","order_by":6,"name":"Yuxin Chen","email":"","orcid":"","institution":"Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuxin","middleName":"","lastName":"Chen","suffix":""},{"id":376328194,"identity":"d0f1a93d-f6f7-44c0-8785-0770f4239b16","order_by":7,"name":"Kelin Chen","email":"","orcid":"","institution":"Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Kelin","middleName":"","lastName":"Chen","suffix":""},{"id":376328195,"identity":"9034de73-aafd-451e-8614-5438b06467ba","order_by":8,"name":"Guojun Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYJACAzjxASoiQbQWxhnEaoHrY+YhRot8RPKBYt4dDPbm7GcPv7apsYs2OMB88DYPg10eLi2GN9ISjHnPMDBb9uSlWeccS87dcIAt2ZqHIbkYp5YZOQbGvG0MbAYHcsyMcxsOALXwmEnzMBxIbCCghcfg/BszY0uwFv5veLXIS0C0SBjcyDF+zAixhQ2vFgOeZwmGc9skDAxuvDFj7AH6ZeZhNmPLOQbJuG1pTz5m8LbNxt7gfI7xhx81drl9x5sf3nhTYYfblgNAn0Mjgg0SHcxgcRzqQbY0MDA/gLKZP+BWNwpGwSgYBSMZAABeQlJDCnHIwwAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University","correspondingAuthor":true,"prefix":"","firstName":"Guojun","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-10-25 08:23:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5330730/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5330730/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69441107,"identity":"a10e7a3f-609d-4f17-a064-bb5132fd3795","added_by":"auto","created_at":"2024-11-20 11:20:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":137316,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProportional distribution of recurrent GBS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHematocrit scale was set according to the quartile levels of the enrolled recurrent GBS patients. The proportion of recurrent GBS tended to increase with increasing hematocrit levels.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5330730/v1/1c7c8e7affd630ba718b9d9f.png"},{"id":69443359,"identity":"5c020be0-41e8-438f-b953-5d9e9d4d4f66","added_by":"auto","created_at":"2024-11-20 11:36:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":740576,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5330730/v1/48a26ba5-3627-4c69-a4f6-38c9e7a8849f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hematocrit is an independent risk factor of recurrent Guillain-Barré syndrome","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eGuillain-Barr\u0026eacute; Syndrome (GBS) is an autoimmune-mediated inflammatory demyelinating disease affecting peripheral nerves and nerve roots. Approximately two-thirds of patients have a preceding infection. Clinically, it presents with various symptoms such as rapidly progressing limb weakness, decreased tendon reflexes, and reduced muscle tone [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The incidence of GBS has been increasing in recent years, making it one of the most common causes of acute delayed paralysis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is generally considered to be a monophasic disease, yet some patients experience relapses after long periods of remission. The incidence of recurrent GBS has been estimated at approximately 2\u0026ndash;6.8% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Recurrent GBS is marked by recurrent episodes and remission phases with similar clinical manifestations but without clear correlation between episodes. Patients often recover complete or nearly complete during the intervals between episodes.\u003c/p\u003e \u003cp\u003eThere have been limited investigations on recurrent GBS, primarily comprising special case reports. Recurrent GBS predominantly affected young males and different GBS subtypes were observed to recur [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Previous respiratory and gastrointestinal infections have been associated with recurrent GBS [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Elevated serum levels of thyroid stimulating hormone (TSH) independently increase the risk of recurrent GBS [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A long-term population-based study suggested that recurrent GBS tends to have a shorter duration compared to monophasic GBS. However, no additional immunologic susceptibility factors contributing to relapses beyond those previously identified have been definitively established, and there is no discernible trend towards a significant reduction in recurrence rates [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Recurrent GBS typically presents with a sudden onset, characterized by irregularity and unpredictable recurrence [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. There are limited and contentious studies on assessing risk factors for recurrent GBS. Hence, it is essential to investigate the factors contributing to recurrent GBS and ensure timely intervention and treatment for patients.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Subjects\u003c/h2\u003e \u003cp\u003eAll patients with GBS [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] were retrospectively recruited at Beijing Tiantan Hospital, Capital Medical University from January 2012 to January 2022. The protocol was approved by the Ethics Committee of Beijing Tiantan Hospital (batch number: KY-2022-039-01) and performed in accordance with the Helsinki Declaration of Human Studies. Informed consent was obtained from all subjects and/or their legal guardian(s). A total of 297 GBS patients were included in this study, Based on the follow-up, 29 cases of lost visits and deaths were excluded, and finally 268 patients were enrolled in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data collection\u003c/h2\u003e \u003cp\u003eClinical information of 268 patients with GBS included in the study was collected from the Hospital Information Management System (HIS) of Beijing Tiantan Hospital affiliated with Capital Medical University. This dataset encompassed fundamental demographics such as sex and age, as well as medical history including cigarette smoking, alcohol consumption, systolic blood pressure (SBP), diastolic blood pressure (DBP), hypertension, diabetes mellitus, heart diseases, trauma, surgery, body mass index (BMI), vaccination and preceding infections. Laboratory data of 268 GBS patients were queried from the Laboratory Information Management System (LIS) of Beijing Tiantan Hospital affiliated with Capital Medical University. Laboratory data include white blood cell (WBC), lymphocyte (LY), monocyte (MO), neutrophil (NEUT), hematocrit (HCT), platelet (PLT), platelet volume distribution width (PDW), mean platelet volume (MPV), glucose (GLU), triglyceride (TG), cholesterol (CHO), high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein A1(APOA1), apolipoprotein B (APOB), residual cholesterol (RC), dyslipidemia index, triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4). Dyslipidemia was defined as at least one abnormality in CHO, TG, HDL, LDL, APOA1 or APOB [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and the dyslipidemia index was defined as the number of abnormalities for each of the six indicators.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e \u003cp\u003eSPSS software (version 20.0) was used for statistical analysis. The Normally distributed continuous variables were compared using the Student\u0026rsquo;s t-test, whereas non-normally distributed data were assessed using the Mann-Whitney U test. We performed a multifactorial logistic regression analysis to explore the independent risk factors for recurrent GBS. The Spearman rank correlation coefficient and Mantel\u0026ndash;Haenszel test were performed to analyze the correlation between clinical and laboratory characteristics and risk factor quartile. A p-value less than 0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Comparison of clinical characteristics in recurrent and non-recurrent patients with GBS\u003c/h2\u003e \u003cp\u003eA total of 297 patients with GBS were initially enrolled in this study. After follow-up, 29 cases of lost follow-ups and deaths were excluded, resulting in a final cohort of 268 patients, including 132 cases in recurrent group and 136 cases in non-recurrent group. The clinical characteristics of the recurrent GBS patients and univariate factors associated with the risk of recurrent GBS are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The percentage of vaccination was lower in recurrent group than non-recurrent group, and there was no statistically significant difference between the two groups such as sex, age, cigarette smoking, alcohol consumption, SBP, DBP, hypertension, diabetes mellitus, heart disease, trauma, surgery, BMI and preceding infection.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics in patients with Recurrent GBS and Non-Recurrent GBS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRecurrent GBS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Recurrent GBS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;132\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;136\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83(61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (36, 62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (32.5, 58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCigarette smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (124, 143)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133.5 (120, 144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (75, 91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.5 (78, 90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.22 (21.7, 26.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.34 (22, 26.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.750\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreceding infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64(49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, median (Q1-Q3) or percentage. Abbreviations: DBP, Diastolic blood pressure; SBP, Systolic blood pressure; BMI, Body mass index.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Univariate analysis of laboratory indicators in recurrent and non-recurrent groups\u003c/h2\u003e \u003cp\u003eA univariate analysis was performed on 132 patients with recurrent GBS and 136 patients with non-recurrent GBS for laboratory indicators. The laboratory characteristics of the recurrent GBS patients and univariate factors associated with the risk of recurrent GBS are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The results showed that the levels of HCT and MPV were significantly higher in recurrent group than non-recurrent group, whereas FT3 were lower in recurrent group. The rest of the indices such as WBC, LY, MO, NEUT, PLT, PDW, GLU, TG, CHO, HDL, LDL, APOA1, APOB, RC, dyslipidemia index, T3, T4, TSH, and FT4 were not statistically different.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLaboratory characteristics in patients with Recurrent GBS and Non-Recurrent GBS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRecurrent GBS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Recurrent GBS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;132\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;136\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.91 (5.66, 8.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.84 (5.91, 8.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.71 (1.31, 2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.69 (1.25, 2.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.674\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.45 (0.34, 0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.44 (0.36, 0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNEUT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.64 (3.21, 6.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.50 (3.47, 6.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.9 (0.47, 42.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.05 (0.4, 41.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e237.5 (194.25, 279.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e245.5 (207.25, 292.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8 (11.4, 16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.7 (12.68, 16.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.15 (9.50, 10.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.8 (9.28, 10.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGLU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.90 (4.33, 5.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.71 (4.33, 5.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.24 (0.83, 1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.32 (0.96, 1.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.06 (0.88, 1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.09 (0.96, 1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.45 (1.95, 3.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.39 (1.89, 2.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPO-A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPO-B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0. 22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.47 (0.37, 0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.47 (0.34, 0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.557\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (22%)\u003c/p\u003e \u003cp\u003e28(21.2%)\u003c/p\u003e \u003cp\u003e37 (28%)\u003c/p\u003e \u003cp\u003e35 (26.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (18.4%)\u003c/p\u003e \u003cp\u003e38 (27.9%)\u003c/p\u003e \u003cp\u003e35 (25.7%)\u003c/p\u003e \u003cp\u003e28 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.30 (1.05, 1.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.33 (1.01, 1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102.03 (83.27, 121.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107.28 (91.51, 128.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTSH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.54 (0.90, 2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.57 (0.86, 2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.24 (3.65, 4.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.42 (3.86, 4.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFT4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.33 (11.98, 15.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.53 (12.01, 14.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eWBC: white blood cell; LY: lymphocyte; MO: Monocyte; NEUT: neutrophil; HCT: Hematocrit; PLT: platelet; PDW: platelet volume distribution width; MPV: mean platelet volume; GLU: glucose; TG: triglyceride; CHO: cholesterol; HDL: high-density lipoprotein; LDL: low-density lipoprotein; APOA1: apolipoprotein A1; APOB: apolipoprotein B; RC: residual cholesterol; T3: triiodothyronine; T4: thyroxine; TSH: thyroid-stimulating hormone; FT3: free triiodothyronine; FT4: free thyroxine.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Potential risk factors for recurrent patients with GBS\u003c/h2\u003e \u003cp\u003eVaccination, HCT, MPV and FT3 which were significantly different on univariate analysis and were included in multivariate logistic regression analysis. Multivariate logistic analysis revealed that HCT was an independent risk factor for the recurrence of GBS(OR:1.015;95%CI: 1.001\u0026ndash;1.028༛P\u0026thinsp;=\u0026thinsp;0.032).\u003c/p\u003e \u003cp\u003e3.4 Analysis of clinical characteristics and laboratory indicators of patients with recurrent GBS based on HCT quartiles\u003c/p\u003e \u003cp\u003eThe clinical and laboratory characteristics of recurrent GBS patients based on the HCT are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. HCT quartiles were positively correlated with cigarette smoking, alcohol consumption, LDL, RC, dyslipidemia index, but exhibited a significant negative association with vaccination, T4 and PLR. Crucially, the proportion of recurrent GBS patients increased with the increase in the HCT (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and Laboratory Characteristics of patients with recurrent GBS according to HCT Quartile\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003cp\u003e(\u0026lt;0.41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003cp\u003e(0.41\u0026ndash;36.50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003cp\u003e(36.50-42.45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ4\u003c/p\u003e \u003cp\u003e(\u0026gt;42.45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e trend\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(45.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(57.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27(77.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.5 (32.75, 63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (39, 64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.5 (35.75, 60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53 (35.5, 60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCigarette smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18(51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19(70.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134.12\u0026thinsp;\u0026plusmn;\u0026thinsp;17.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130.03\u0026thinsp;\u0026plusmn;\u0026thinsp;21.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e133.25\u0026thinsp;\u0026plusmn;\u0026thinsp;13.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e134.57\u0026thinsp;\u0026plusmn;\u0026thinsp;17.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (75.75, 93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.5 (78.75, 90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.25 (74.75, 92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78 (72.5, 88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.758\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.88 (22.15, 26.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.24 (20.96, 26.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.62 (21.56, 25.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.48 (23.7, 27.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreceding infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(45.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16(45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.405 (0.3, 0.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.55 (0.43, 0.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49 (0.41, 0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.46 (0.33, 0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (41.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121.08(104.98, 145.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111.19 (88.70, 122.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.14 (78.66, 107.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.67 (85.70, 108.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussions","content":"\u003cp\u003ePatients with GBS frequently have a history of preceding infections before both initial and recurrent episodes. The interval between the appearance of the triggering event and the onset of the disease, as well as between disease onset and peak symptoms, tends to be shorter in recurrent cases compared to initial episodes. Additionally, recurrent cases often exhibit more severe symptoms and signs. The onset of recurrent GBS is abrupt, with symptoms reaching their peak quickly, and there is no significant regularity or predictability in recurrence, with cycles varying from a few months to several years [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Thus, it is of great importance to explore the risk factors for recurrent GBS.\u003c/p\u003e \u003cp\u003eIn this study, we explored the potential risk factors for recurrent GBS, taking clinical and laboratory factors into account. Our results revealed that HCT, MPV, FT3, and vaccination were significantly different in patients with recurrent GBS compared to those without recurrence. Multivariate logistic analysis revealed that HCT was an independent risk factor of recurrent GBS and increased HCT was correlated with a higher risk of recurrent GBS. There is limited research exploring the relationship between HCT levels and GBS. A.M. Richards [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and colleagues reported a case where a GBS patient exhibited high blood pressure and elevated HCT, potentially due to a rapid increase in blood pressure causing a \"stress triad,\" which results in plasma volume depletion and a concomitant rise in hematocrit. An elevated hematocrit was significant predictors of central nervous system, and elevated hematocrit was more prone to developing peripheral nervous system manifestations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurther we analyzed the clinical and laboratory characteristics of recurrent GBS according to HCT quartiles. The findings indicated that HCT quartiles were positively correlated with both cigarette smoking and alcohol consumption. Additionally, prior research has identified cigarette smoking and alcohol use as potential independent risk factors for GBS [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Chronic alcohol intake can adversely affect both the central and peripheral nervous systems. Long-term alcohol consumption is primarily associated with sleep disturbances, chronic pain, cognitive and behavioral disorders, strokes, as well as damage to peripheral nerves and muscles. The mechanisms underlying alcoholic neuropathy remain debated, though it is largely linked to nutritional deficiencies and the neurotoxic effects of alcohol. Recent studies have proposed that alcohol consumption may cause axonal degeneration through oxidative stress, the release of pro-inflammatory cytokines, and the activation of protein kinase C [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, instances of GBS induced by alcohol have been documented [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The positive correlation observed between cigarette smoking and HCT quartiles may stem from smoking's role in elevating erythropoietin levels [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Nonetheless, the connections among HCT, cigarette smoking, and alcohol consumption, as well as their contributions to the pathogenesis of GBS and recurrent GBS, require further investigation.\u003c/p\u003e \u003cp\u003eOur study demonstrated that levels of LDL, RC, and dyslipidemia indices significantly increased with higher HCT levels. Previous research has identified RC and dyslipidemia as independent risk factors for both GBS and severe GBS. Elevated RC levels and dyslipidemia indices were linked to a higher incidence of severe GBS and corresponded with increased GBS disability scores [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Notably, GBS patients experienced a significant decrease in total cholesterol (TC) following intravenous immunoglobulin therapy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Some studies have established a connection between altered lipid metabolism and peripheral nerve dysfunction. Disruptions in cholesterol metabolism may compromise myelin integrity, which is targeted by the immune system in certain forms of GBS [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Additionally, LDL and serum TC levels have been associated with cognitive impairment in patients with multiple sclerosis (MS) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In type 2 diabetes, dyslipidemia can adversely affect dorsal root ganglion neurons and induce mitochondrial dysfunction [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Furthermore, elevated levels of LDL cholesterol in midlife have been linked to an increased risk of Alzheimer\u0026rsquo;s disease in old age [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, the interactions between HCT and lipid levels, as well as their roles in patients with recurrent GBS, remain unclear.\u003c/p\u003e \u003cp\u003eConsistent with previous research, our findings revealed low levels of FT3 in patients with recurrent GBS. In contrast to earlier studies, we did not observe elevated TSH levels as an independent risk factor for recurrent GBS. However, we identified a negative correlation between T4 levels and HCT quartiles [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This discrepancy may be attributed to the sample size and the confounding effects inherent in multifactorial regression analysis. One study indicated that, compared to healthy controls, GBS patients exhibited lower TSH levels and higher FT4 and FT4/FT3 ratios, which were linked to the incidence and severity of GBS [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Additionally, some studies have suggested that thyroid hormone levels correlate with oxidative and antioxidant status. Recent research has demonstrated that increased reactive oxygen species (ROS) and an imbalance between malondialdehyde (MDA) and antioxidant activity in the plasma of GBS patients, compared to healthy individuals, may activate the mitogen-activated protein (MAP) kinase pathway in Schwann cells, leading to subsequent axonal damage [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. A wide range of research have shown that the myelination process in patients with multiple sclerosis is influenced by thyroid hormones, which can enhance remyelination and mitigate demyelination by shifting the demyelination/remyelination balance in favor of remyelination and promoting the development of oligodendrocyte lineage cells [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These findings suggest a potential association between thyroid hormones and GBS. Nevertheless, the specific role of thyroid hormones in recurrent GBS and their relationship with HCT warrant further investigation at this time.\u003c/p\u003e \u003cp\u003eInfection with the novel coronavirus (COVID-19), influenza, and various vaccinations may induce the onset or recurrence of GBS, although related research remains contentious [\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In our study, we found that the percentage of vaccinated individuals experiencing recurrent GBS was significantly lower. Additionally, as HCT levels rose, the proportion of vaccinated patients with recurrent GBS also markedly diminished. This finding contradicts the established association between vaccinations and GBS noted in earlier studies, likely due to differences in sample sizes and the absence of specific vaccine type categorization. More research is essential to clarify the effects of vaccination on GBS and its recurrence.\u003c/p\u003e"},{"header":"5 Conclusions","content":"\u003cp\u003eHematocrit (HCT) is an independent risk factor for the recurrence of GBS. As HCT levels increase, the risk of GBS recurrence also rises, leading to a higher incidence of recurring cases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWillison HJ, Jacobs BC, van Doorn PA. Guillain-Barr\u0026eacute; syndrome. Lancet. 2016 Aug 13; 388(10045):717-27. \u003c/li\u003e\n\u003cli\u003eShahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barr\u0026eacute; syndrome. 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FASEB J. 2018 Jan;32(1):195-207.\u003c/li\u003e\n\u003cli\u003eDias HK, Brown CL, Polidori MC, Lip GY, Griffiths HR. LDL-lipids from patients with hypercholesterolaemia and Alzheimer\u0026apos;s disease are inflammatory to microvascular endothelial cells: mitigation by statin intervention. Clin Sci (Lond). 2015 Dec;129(12):1195-206.\u003c/li\u003e\n\u003cli\u003eHuang Y, Ying Z, Chen Z, Xiang W, Su Z, Quan W, Weng Y, Zhang X. Thyroid hormone level is associated with the frequency and severity of Guillain-Barr\u0026eacute; syndrome. Int J Neurosci. 2017 Oct;127(10):893-899.\u003c/li\u003e\n\u003cli\u003eSmith KJ, Kapoor R, Felts PA. Demyelination: the role of reactive oxygen and nitrogen species. Brain Pathol. 1999 Jan;9(1):69-92.\u003c/li\u003e\n\u003cli\u003eRodella U, Scorzeto M, Duregotti E, Negro S, Dickinson BC, Chang CJ, Yuki N, Rigoni M, Montecucco C. An animal model of Miller Fisher syndrome: Mitochondrial hydrogen peroxide is produced by the autoimmune attack of nerve terminals and activates Schwann cells. Neurobiol Dis. 2016 Dec;96:95-104.\u003c/li\u003e\n\u003cli\u003eZhang M, Ma Z, Qin H, Yao Z. Thyroid Hormone Potentially Benefits Multiple Sclerosis via Facilitating Remyelination. Mol Neurobiol. 2016 Sep;53(7):4406-16.\u003c/li\u003e\n\u003cli\u003eMcDonnell EP, Altomare NJ, Parekh YH, Gowda RC, Parikh PD, Lazar MH, Blaser MJ. COVID-19 as a Trigger of Recurrent Guillain-Barr\u0026eacute; Syndrome. Pathogens. 2020 Nov 19;9(11):965.\u003c/li\u003e\n\u003cli\u003eShapiro Ben David S, Potasman I, Rahamim-Cohen D. Rate of Recurrent Guillain-Barr\u0026eacute; Syndrome After mRNA COVID-19 Vaccine BNT162b2. JAMA Neurol. 2021 Nov 1;78(11):1409-1411. \u003c/li\u003e\n\u003cli\u003eGriffin G, Cunningham B, Beary JM, Spolter Y, Gandee R, Newey CR. Lighting Strikes Twice: Recurrent Guillain-Barr\u0026eacute; Syndrome (GBS) after Influenza Vaccination. Case Rep Neurol Med. 2021 Feb 3;2021:6690643. \u003c/li\u003e\n\u003cli\u003eMiletic Drakulic SD, Lazarevic SR, Miloradovic IP, Jankovic VS. Reccurent guillain barr\u0026eacute; syndrome after COVID-19. Neurosciences (Riyadh). 2023 Oct;28(4):273-276. doi: 10.17712/nsj.2023.4.20230012. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Recurrent Guillain-Barré syndrome, hematocrit","lastPublishedDoi":"10.21203/rs.3.rs-5330730/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5330730/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eGuillain-Barré Syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system, characterized by progressive weakness and diminished or absent myotatic reflexes. While GBS typically exhibits a monophasic course, recurrent episodes can occur in certain patients. This study aimed to explore potential risk factors associated with recurrent GBS. We conducted a retrospective analysis involving GBS patients admitted to Beijing Tiantan Hospital between January 2012 and January 2022. Patients were categorized into recurrent and non-recurrent groups based on follow-up outcomes, meanwhile, clinical and laboratory data were compared between the two cohorts. Then, we integrated statistically significant indicators to identify independent risk factors for recurrent GBS using multifactorial logistic regression. Univariate analysis revealed that hematocrit (HCT) and mean platelet volume (MPV) were significantly elevated, whereas free triiodothyronine (FT3) and the percentage of vaccination was lower in patients with recurrent GBS compared to non-recurrent groups. Multifactorial logistic regression analysis revealed HCT (OR:1.015;95%CI: 1.001–1.028༛P = 0.032) is an independent risk factor for recurrent GBS. Elevated serum HCT levels correlate with an increased risk of recurrent GBS. Crucially, the incidence of recurrent GBS patients rises in tandem with rising serum HCT levels.\u003c/p\u003e","manuscriptTitle":"Hematocrit is an independent risk factor of recurrent Guillain-Barré syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-20 11:20:13","doi":"10.21203/rs.3.rs-5330730/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"64822583-e94d-494b-ab78-4f4a7f129e80","owner":[],"postedDate":"November 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-20T11:20:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-20 11:20:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5330730","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5330730","identity":"rs-5330730","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}