title: Effect of intravenous immunoglobulin for fulminant myocarditis on in-hospital mortality: propensity score analyses.
abstract: BACKGROUND
  Fulminant myocarditis (FM) is a rare but life-threatening disease. Intravenous immunoglobulin (IVIG) is not recommended for acute or chronic myocarditis in Western nations owing to the lack of rigorous evidence, but it is widely used in other countries, including Japan. This nationwide retrospective cohort study focused on evaluating the effect of IVIG in FM patients.
  
  
  RESULTS
  Using the Diagnosis Procedure Combination database in Japan, we identified 603 FM patients aged ≥16 years who received mechanical circulatory support within 7 days after admission. We performed propensity score analyses to compare the in-hospital mortality and total costs between IVIG users (n = 220; 36.5%) and nonusers (n = 383; 63.5%). Among propensity score-matched patients (164 pairs), there was no significant difference in in-hospital mortality between IVIG users and nonusers (36.6% vs 37.2%; P = .909). A multivariable logistic regression analysis showed no significant association between IVIG use and in-hospital mortality (adjusted odds ratio 0.91; 95% confidence interval 0.52 to 1.58; P = .733). The median total costs were significantly higher for IVIG users than for nonusers (US $44,226 vs $33,280; P < .001).
  
  
  CONCLUSIONS
  IVIG for FM was not significantly associated with a decrease in in-hospital mortality.
authors: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. Electronic address: toisogai-circ@umin.ac.jp.
authors: Toshiaki
authors: T
authors: Isogai
authors: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors: Hideo
authors: H
authors: Yasunaga
authors: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors: Hiroki
authors: H
authors: Matsui
authors: Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors: Hiroyuki
authors: H
authors: Tanaka
authors: Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
authors: Hiromasa
authors: H
authors: Horiguchi
authors: Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Kiyohide
authors: K
authors: Fushimi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors
keywords: Fulminant myocarditis; immunoglobulin; mortality; propensity score analysis