Épidémiologie de l’utilisation de l’immunoglobuline intraveineuse dans les cas de choc septique : une analyse de cohorte rétrospective de la base de données Premier Healthcare

Translated title of the contribution: Epidemiology of intravenous immune globulin in septic shock: a retrospective cohort analysis of the Premier Healthcare Database

Murdoch Leeies, Hayley B. Gershengorn, Emmanuel Charbonney, Anand Kumar, Dean A. Fergusson, Alexis F. Turgeon, Allan Garland, Donald S. Houston, Brett Houston, Emily Rimmer, Eric Jacobsohn, Srinivas Murthy, Rob Fowler, Robert Balshaw, Ryan Zarychanski

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Intravenous immune globulin (IVIG) may improve survival in people with septic shock. Current utilization patterns of IVIG are unknown. We sought to characterize adult patients with septic shock requiring vasopressors who received IVIG, describes IVIG regimens, and evaluate determinants of IVIG use in patients with septic shock. Methods: We conducted a retrospective database study of adult patients with septic shock admitted to US hospitals in the Premier Healthcare Database (from July 2010 to June 2013). We described the proportion of patients with septic shock receiving IVIG, examined IVIG regimens across sites and employed random-effects multivariable regression techniques to identify predictors of IVIG use. Results: Intravenous immune globulin was administered to 0.3% (n = 685) of patients with septic shock; with a median [interquartile range (IQR)] dose of 1 [0.5–1.8] g·kg-1 for a median [IQR] of 1 [1–2] day. Receipt of IVIG was less likely for Black patients (odds ratio [OR], 0.54; 95% confidence interval [CI] 0.41 to 0.72) and patients without private insurance (Medicare OR, 0.73; 95% CI 0.59 to 0.90; Medicaid OR, 0.41; 95% CI 0.30 to 0.57) and more likely for patients with immunocompromise (OR, 6.83; 95% CI 5.47 to 8.53), necrotizing fasciitis (OR, 9.78; 95% CI 6.97 to 13.72), and toxic shock (OR, 56.9; 95% CI 38.7 to 83.7). Conclusions: Intravenous immune globulin is used infrequently across the US in patients with septic shock. Regimens of IVIG in septic shock may be less intensive than those associated with a survival benefit in meta-analyses. Observed infrequent use supports apparent clinical equipoise, perhaps secondary to limitations of the primary literature. A clinical trial evaluating the role of IVIG in septic shock is needed.

Translated title of the contributionEpidemiology of intravenous immune globulin in septic shock: a retrospective cohort analysis of the Premier Healthcare Database
Original languageFrench
Pages (from-to)1641-1650
Number of pages10
JournalCanadian Journal of Anesthesia
Volume68
Issue number11
DOIs
StatePublished - Nov 2021

Keywords

  • IVIG
  • Immunomodulation
  • Intravenous immune globulin
  • Septic shock

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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