Immunotherapy for Guillain-Barré syndrome in the US hospitals.

OBJECTIVES: To determine the patterns of hospital utilization of plasma exchange (PE), intravenous immunoglobulin (IVIG), or combination therapy in Guillain-Barré syndrome in a large US cohort.

METHODS: Guillain-Barré syndrome patients, older than 18 years, were identified from the Nationwide Inpatient Sample database for the years 2000 through 2005. Patients with documented immunotherapy during hospitalization were included. We used the Cochran-Armitage test to assess the trend of hospital utilization of the type of immune intervention over time. Binomial logistic regression model was used to identify the association between patient and hospital demographics and hospital- associated complications with the type of therapy administered during hospitalization.

RESULTS: After data cleansing, 1657 patients were included. There is a decreasing trend in PE utilization and an increasing trend in IVIG use over the 6 years included in this study (P < 0.0001). Patients who received PE were older (mean age of 50.8 +/- 18.5 versus 42.2 +/- 24.2, P < 0.0001) and had higher complication rates including respiratory failure (18.9% versus 7.56%, P < 0.0001) and sepsis (2.85% versus 0.61%, P = 0.003). In addition, the mortality rate is lower in the group treated with IVIG when compared with PE (0.45% versus 3.3%, P < 0.0001). Conversely, 61% of patients treated with IVIG group were discharged to home compared with 42% of patients treated with PE.

CONCLUSIONS: The trend analysis supports an increasing use of IVIG over PE. Older population and those with pulmonary or sepsis complications were likely treated with PE. The mortality rate was higher in patients treated with PE.