LIVER-FUNCTION DISTURBANCES IN GUILLAIN-BARRE-SYNDROME - A PROSPECTIVE LONGITUDINAL-STUDY IN 100 PATIENTS

In 100 consecutive patients with Guillain-Barre syndrome, we assessed liver function on admission and at fixed intervals after either intrav enous immunoglobulin (IgIV) or plasma-exchange (PE) treatment. On admi ssion, 38% showed a plasma alanine aminotransferase elevation, gamma g lutamyl transferase elevation, or both of more than 1.5 times the uppe r limit of normal. Ten of these patients had serologic evidence of rec ent cytomegalovirus infection. The remaining 28 patients were negative for other known causes of liver damage, including infection with Epst ein-Barr virus or hepatitis A, B, and C; alcohol abuse; hepatotoxic dr ugs; recent surgery; and concurrent liver disease. In a hospital contr ol group of 100 consecutive patients with subarachnoid hemorrhage, onl y 5 had unexplained liver function disturbances on admission (p < 0.00 01). In the IgIV-treated group, the percentage of patients with elevat ed liver function tests increased from 35% before to 69% shortly after treatment at 2 weeks postadmission (p < 0.005). In the PE-treated gro up, this percentage decreased somewhat from 41% to 36% (not significan t). There was also a significant rise in median plasma activity of the various liver enzymes in the IgIV group. At 1 month, however, signifi cant difference had disappeared. At 3 and 6 months, the percentage of patients with liver function disturbances reached a significantly lowe r level in both treatment groups compared with the time of admission. We concluded that many patients with Guillain-Barre syndrome had mild liver function disturbances without obvious cause. In addition, IgIV t reatment was associated with mild transient liver function disturbance s through an unknown mechanism.