title: Outcome of plasmapheresis in myasthenia gravis: delayed therapy is not favorable.
abstract: BACKGROUND
  The purpose of this study was to compare the in-hospital mortality and complication rates after early and delayed initiation of plasma exchange (PLEX) in patients with myasthenia gravis (MG).
  
  
  METHODS
  Our cohort was identified from the Nationwide Inpatient Sample database for the years 2000 through 2005. Early treatment was defined as therapy with PLEX administered within the first 2 days from hospital admission. Univariate and multivariate analyses were employed.
  
  
  RESULTS
  One thousand fifty-three patients were treated and included in the analysis. A delay in receiving PLEX was associated with higher mortality (6.56% vs. 1.15%, P < 0.001) and increased complications (29.51% vs. 15.29%, P < 0.001). Adjusted analysis showed increased mortality [odds ratio (OR) 2.812; 95% confidence interval (CI) 1.119-7.069] and complications (OR 1.672; 95% CI 1.118-2.501) with delayed PLEX therapy.
  
  
  CONCLUSIONS
  Delaying PLEX therapy for MG by more than 2 days after admission may lead to higher mortality and complication rates, and thus prompt therapy is warranted.
authors.affiliation: Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Mandawat
authors.forename: Anant
authors.initials: A
authors.lastname: Mandawat
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Kaminski
authors.forename: Zaid A
authors.initials: ZA
authors.lastname: Shaker
authors.forename: Aws A
authors.initials: AA
authors.lastname: Alawi
authors.forename: Amer
authors.initials: A
authors.lastname: Alshekhlee
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010351:Patient Discharge / Q000639:trends; D010956:Plasmapheresis / Q000379:methods* / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome