title: Immunotherapy for Guillain-Barré syndrome in the US hospitals.
abstract: OBJECTIVE
  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.
authors.affiliation: Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106-5040, USA. amer.alshekhlee@uhhospitals.org
authors.forename: Amer
authors.initials: A
authors.lastname: Alshekhlee
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Hussain
authors.forename: Badr
authors.initials: B
authors.lastname: Sultan
authors.forename: Bashar
authors.initials: B
authors.lastname: Katirji
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications / Q000453:epidemiology / Q000276:immunology* / Q000628:therapy*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007155:Immunologic Factors / Q000008:administration & dosage; D007167:Immunotherapy / Q000379:methods* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors