Category: Neurodegenerative Disease (e.g. MS, Parkinson's disease); Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Guillain-Barré syndrome (GBS) is an acute post-infectious demyelinating polyneuropathy characterized by symmetric and ascending flaccid paralysis. Standard therapy for symptomatic GBS include plasma exchange(PLEX), known as plasmapheresis, and intravenous immunoglobulin(IVIG). To date, neither PLEX or IVIG has established superior clinical benefit. This study aims to compare PLEX vs. IVIG in patients with GBS.
This retrospective cohort study utilized the Nationwide Inpatient Sample to identify patients(18+) from 2012-2015 using ICD-9 codes with a diagnosis of GBS who underwent either PLEX or IVIG. Any patients missing identifiers(age, gender, death) were excluded. Patients recieving both PLEX and IVIG during the same hospitalization were excluded as combined treatment may affect outcomes. Data analyses assessed length of stay(LOS), total hospital charges, mortality and age of admission.
Setting : Nationwide Inpatient Sample Administrative Database,2012-2015
Participants (or Animals, Specimens, Cadavers) :
Patient encounters documented in Nationwide Inpatient Sample Database.
Main Outcome Measure(s) :
Mortality, total in-hospital charges, length of stay, age of admission
Of the 2,472 patients receiving either PLEX or IVIG, 845 patients underwent PLEX vs. 1,627 patients underwent IVIG treatment. In comparison to patients receiving IVIG, significant increases were observed in the PLEX group:
· LOS(8.93 days vs. 15.9 days,p
· Total charges($117,189.81 vs. $189,921.75,p
· Mortality(1.9% vs. 3.0%,p=0.002)
There were no significant differences between IVIG vs. PLEX for age of admission(55.49 vs. 54.07 years,p=0.336).
Conclusions : Patients who underwent PLEX suffer from increased LOS, mortality, and total charges when compared to IVIG. The results of this study can aid clinicians in making treatment decisions within this population. Limitations include inability to determine length of treatment or severity of GBS. Peri-procedural optimization of symptomatic patients is one potential avenue to improve patient outcomes.
Andrew Dang– Anatomy Fellow, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
Derek Schirmer– Anatomy Fellow, Kansas city university of medicine and Biosciences, Kansas City, Missouri
Russell Arellanes– Anatomy fellow, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
Barth Wright– Professor, Chair, Dept. of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, Missouri