Comparison of intravenous immunoglobulin and plasma exchange in hospital-acquired infections of autoimmune encephalitis in a tertiary care center.

IF 0.9 4区医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL

Asian Biomedicine Pub Date : 2025-07-28 eCollection Date: 2025-06-01 DOI:10.2478/abm-2025-0018

Totsapol Surawattanawong, Akarin Hiransuthikul, Panthicha Katasrila, Thiravat Hemachudha, Abhinbhen W Saraya

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引用次数: 0

Abstract

Background: The prevailing approach for the acute-phase treatment of autoimmune encephalitis (AIE) is currently the administration of intravenous immunoglobulin (IVIG) or plasma exchange (PLEX), in conjunction with high-dose corticosteroids. Despite this, there is still no definitive evidence on the risks and benefits of IVIG vs. PLEX in terms of treatment-related complications.

Objectives: The primary objective of this study was to determine the differences in the cumulative incidence of hospital-acquired infections (HAIs) in patients diagnosed with AIE, who received either IVIG or PLEX. The secondary objectives were to explore the differences in the duration of hospitalization and levels of disability.

Methods: Patients who were hospitalized at the King Chulalongkorn Memorial Hospital, Thailand, due to AIE, were aged ≥15 years, and had received either IVIG or PLEX during their hospitalization from January 2015 to December 2020 were included in the study. The modified Rankin scale (mRS) was utilized to evaluate the degree of disability at admission and discharge.

Results: Among the 44 patients included in the study, 10 (22.7%) received PLEX and 34 (77.3%) received IVIG. Those who received IVIG were significantly less likely to have HAIs (14.7% vs. 50.0%, P = 0.03) and had a significantly shorter duration of hospitalization (median [IQR] 12.0 [6.0 - 23.0] vs. 25.0 [21.0 - 49.0] d, P = 0.01) compared to those who received PLEX. Primary septicemia was the most commonly observed cause of infection in both groups. There were no significant differences in mRS at discharge, changes in mRS between admission and discharge, and the total direct cost of hospitalization between the two groups.

Conclusions: The utilization of IVIG is associated with a diminished occurrence of nosocomial infections, leading to shorter hospitalization and potential cost benefits. Our findings propose that IVIG may represent a more beneficial therapeutic alternative for AIE patients compared with PLEX.

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某三级医疗中心自身免疫性脑炎院内获得性感染的静脉注射免疫球蛋白与血浆交换的比较

背景：目前，自身免疫性脑炎（AIE）急性期治疗的主要方法是静脉注射免疫球蛋白（IVIG）或血浆置换（PLEX），并联合大剂量皮质类固醇。尽管如此，在治疗相关并发症方面，仍然没有明确的证据表明IVIG与PLEX的风险和益处。目的：本研究的主要目的是确定接受IVIG或PLEX治疗的AIE患者医院获得性感染（HAIs）累积发生率的差异。次要目标是探讨住院时间和残疾程度的差异。方法：纳入2015年1月至2020年12月在泰国朱拉隆功国王纪念医院因AIE住院的年龄≥15岁且住院期间接受过IVIG或PLEX治疗的患者。采用改良Rankin量表（mRS）评价患者入院和出院时的残疾程度。结果：纳入研究的44例患者中，10例（22.7%）接受了PLEX， 34例（77.3%）接受了IVIG。与接受PLEX的患者相比，接受IVIG的患者发生HAIs的可能性显著降低（14.7%比50.0%,P = 0.03），住院时间显著缩短（中位[IQR] 12.0[6.0 - 23.0]比25.0 [21.0 - 49.0]d, P = 0.01）。原发性败血症是两组中最常见的感染原因。两组患者出院时mRS、入院与出院时mRS变化及住院总直接费用均无显著差异。结论：IVIG的使用与院内感染发生率的降低有关，从而缩短住院时间和潜在的成本效益。我们的研究结果表明，与PLEX相比，IVIG可能是AIE患者更有益的治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asian Biomedicine 医学-医学：研究与实验

CiteScore

1.20

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Asian Biomedicine: Research, Reviews and News (ISSN 1905-7415 print; 1875-855X online) is published in one volume (of 6 bimonthly issues) a year since 2007. [...]Asian Biomedicine is an international, general medical and biomedical journal that aims to publish original peer-reviewed contributions dealing with various topics in the biomedical and health sciences from basic experimental to clinical aspects. The work and authorship must be strongly affiliated with a country in Asia, or with specific importance and relevance to the Asian region. The Journal will publish reviews, original experimental studies, observational studies, technical and clinical (case) reports, practice guidelines, historical perspectives of Asian biomedicine, clinicopathological conferences, and commentaries Asian biomedicine is intended for a broad and international audience, primarily those in the health professions including researchers, physician practitioners, basic medical scientists, dentists, educators, administrators, those in the assistive professions, such as nurses, and the many types of allied health professionals in research and health care delivery systems including those in training.