Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain-Barré syndrome.

ABSTRACT

BACKGROUND: We compared outcomes of therapeutic plasma exchange (TPE) vs intravenous immunoglobulin (IVIG) among hospitalized patients diagnosed with Guillain-Barré syndrome (GBS). METHODS: In a retrospective cohort study of 6642 records (2637 TPE and 4005 IVIG) from the 2002-2014 Nationwide Inpatient Sample, treatment type was examined as predictor of length of stay, total charges, and in-hospital death, with regression modeling using risk adjustment and propensity scoring to control for confounders. RESULTS: Compared with those receiving IVIG, patients who underwent TPE experienced prolonged hospitalization by approximately 7.5 days, greater hospitalization costs by approximately $46,000, and increased in-hospital death with an odds ratio of 2.78. Results did not change after controlling for confounders through risk adjustment, propensity score adjustment, or matching. CONCLUSIONS: TPE may be associated with poorer healthcare utilization outcomes vs IVIG, although confounding by indication could not be ascertained.