Murdoch Leeies1, Hayley B Gershengorn2,3, Emmanuel Charbonney4, Anand Kumar5, Dean A Fergusson6,7,8, Alexis F Turgeon9,10, Allan Garland11, Donald S Houston12, Brett Houston12, Emily Rimmer12, Eric Jacobsohn13, Srinivas Murthy14, Rob Fowler15, Robert Balshaw16, Ryan Zarychanski11,12. 1. Department of Emergency Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada. mleeies@hsc.mb.ca. 2. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA. 3. Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. 4. Department of Medicine, Critical Care, Université de Montréal, Montreal, QC, Canada. 5. Section of Critical Care Medicine, Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada. 6. Departments of Medicine, Surgery, Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 7. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 8. Adjunct Scientist, Canadian Blood Services, Ottawa, Canada. 9. Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada. 10. CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Unit (Trauma - Emergency - Critical Care Medicine),, Québec City, QC, Canada. 11. Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada. 12. Department of Medical Oncology & Hematology, Cancercare Manitoba, Winnipeg, MB, Canada. 13. Section of Critical Care Medicine, Department of Anesthesiology, University of Manitoba, Winnipeg, MB, Canada. 14. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. 15. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 16. George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
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.
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.
Authors: Muhammad Mamdani; Kathy Sykora; Ping Li; Sharon-Lise T Normand; David L Streiner; Peter C Austin; Paula A Rochon; Geoffrey M Anderson Journal: BMJ Date: 2005-04-23
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Authors: 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 Journal: Can J Anaesth Date: 2021-08-10 Impact factor: 6.713
Authors: Marta O Soares; Nicky J Welton; David A Harrison; Piia Peura; Manu Shankar-Hari; Sheila E Harvey; Jason Madan; Anthony E Ades; Kathryn M Rowan; Stephen J Palmer Journal: Crit Care Date: 2014-12-01 Impact factor: 9.097
Authors: 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 Journal: Can J Anaesth Date: 2021-08-10 Impact factor: 6.713