Safety of intravenous immunoglobulin and plasma exchange in critically ill patients

Sarah L. Clark, Alejandro Rabinstein

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To assess the safety profile of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) when used to treat critically ill patients. Methods: We performed a retrospective analysis of consecutive patients who received IVIG or PLEX while admitted to our medical intensive care unit (ICU), neuroscience ICU or haematologic/oncologic ICU between 2007 and 2011.Patients who were transferred into an ICU while receiving therapy or who continued therapy after discharge from the ICU were included in the analysis. Results: A total of 118 consecutive patients were included in the study. Fifty-nine patients received IVIG. Twenty of these patients (34%) developed renal failure during the hospitalisation, including 15 (25.4%) in whom renal function worsened during or shortly after IVIG administration and 4 (6.8%) in whom IVIG was considered a possible cause. Transfusion reactions occurred in five patients (8%). Seven patients (12%) did not receive the full intended course of IVIG. Thirty-four patients (58%) who received IVIG died during their hospitalisation. Fifty-nine patients received PLEX. Hypotension requiring an intervention was noted with 39 sessions (8.5%) and led to discontinuation of the session in 11 (2.4%). Other adverse events included line-related infections (n=4), pneumothorax (n=4) and electrolyte abnormalities and transfusion reactions (n=10). Six patients (10%) did not receive full intended treatment course of PLEX. Nineteen patients (32%) treated with PLEX died during their hospitalisation. Discussion: Intravenous immunoglobulin and PLEX are generally well tolerated by critically ill patients. Intravenous immunoglobulin was associated with worsening renal function in one-quarter of patients.

Original languageEnglish (US)
Pages (from-to)593-598
Number of pages6
JournalNeurological Research
Volume37
Issue number7
DOIs
StatePublished - Jan 1 2015

Fingerprint

Plasma Exchange
Intravenous Immunoglobulins
Critical Illness
Safety
Intensive Care Units
Hospitalization
Kidney
Pneumothorax
Neurosciences
Intravenous Administration
Hypotension
Electrolytes
Renal Insufficiency

Keywords

  • Adverse events
  • Critical care
  • Intensive care unit
  • Intravenous immunoglobulin
  • Plasma exchange
  • Safety

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Safety of intravenous immunoglobulin and plasma exchange in critically ill patients. / Clark, Sarah L.; Rabinstein, Alejandro.

In: Neurological Research, Vol. 37, No. 7, 01.01.2015, p. 593-598.

Research output: Contribution to journalArticle

@article{3897d5b594004691b4987c3c382e497e,
title = "Safety of intravenous immunoglobulin and plasma exchange in critically ill patients",
abstract = "Objective: To assess the safety profile of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) when used to treat critically ill patients. Methods: We performed a retrospective analysis of consecutive patients who received IVIG or PLEX while admitted to our medical intensive care unit (ICU), neuroscience ICU or haematologic/oncologic ICU between 2007 and 2011.Patients who were transferred into an ICU while receiving therapy or who continued therapy after discharge from the ICU were included in the analysis. Results: A total of 118 consecutive patients were included in the study. Fifty-nine patients received IVIG. Twenty of these patients (34{\%}) developed renal failure during the hospitalisation, including 15 (25.4{\%}) in whom renal function worsened during or shortly after IVIG administration and 4 (6.8{\%}) in whom IVIG was considered a possible cause. Transfusion reactions occurred in five patients (8{\%}). Seven patients (12{\%}) did not receive the full intended course of IVIG. Thirty-four patients (58{\%}) who received IVIG died during their hospitalisation. Fifty-nine patients received PLEX. Hypotension requiring an intervention was noted with 39 sessions (8.5{\%}) and led to discontinuation of the session in 11 (2.4{\%}). Other adverse events included line-related infections (n=4), pneumothorax (n=4) and electrolyte abnormalities and transfusion reactions (n=10). Six patients (10{\%}) did not receive full intended treatment course of PLEX. Nineteen patients (32{\%}) treated with PLEX died during their hospitalisation. Discussion: Intravenous immunoglobulin and PLEX are generally well tolerated by critically ill patients. Intravenous immunoglobulin was associated with worsening renal function in one-quarter of patients.",
keywords = "Adverse events, Critical care, Intensive care unit, Intravenous immunoglobulin, Plasma exchange, Safety",
author = "Clark, {Sarah L.} and Alejandro Rabinstein",
year = "2015",
month = "1",
day = "1",
doi = "10.1179/1743132815Y.0000000017",
language = "English (US)",
volume = "37",
pages = "593--598",
journal = "Neurological Research",
issn = "0161-6412",
publisher = "Maney Publishing",
number = "7",

}

TY - JOUR

T1 - Safety of intravenous immunoglobulin and plasma exchange in critically ill patients

AU - Clark, Sarah L.

AU - Rabinstein, Alejandro

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objective: To assess the safety profile of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) when used to treat critically ill patients. Methods: We performed a retrospective analysis of consecutive patients who received IVIG or PLEX while admitted to our medical intensive care unit (ICU), neuroscience ICU or haematologic/oncologic ICU between 2007 and 2011.Patients who were transferred into an ICU while receiving therapy or who continued therapy after discharge from the ICU were included in the analysis. Results: A total of 118 consecutive patients were included in the study. Fifty-nine patients received IVIG. Twenty of these patients (34%) developed renal failure during the hospitalisation, including 15 (25.4%) in whom renal function worsened during or shortly after IVIG administration and 4 (6.8%) in whom IVIG was considered a possible cause. Transfusion reactions occurred in five patients (8%). Seven patients (12%) did not receive the full intended course of IVIG. Thirty-four patients (58%) who received IVIG died during their hospitalisation. Fifty-nine patients received PLEX. Hypotension requiring an intervention was noted with 39 sessions (8.5%) and led to discontinuation of the session in 11 (2.4%). Other adverse events included line-related infections (n=4), pneumothorax (n=4) and electrolyte abnormalities and transfusion reactions (n=10). Six patients (10%) did not receive full intended treatment course of PLEX. Nineteen patients (32%) treated with PLEX died during their hospitalisation. Discussion: Intravenous immunoglobulin and PLEX are generally well tolerated by critically ill patients. Intravenous immunoglobulin was associated with worsening renal function in one-quarter of patients.

AB - Objective: To assess the safety profile of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) when used to treat critically ill patients. Methods: We performed a retrospective analysis of consecutive patients who received IVIG or PLEX while admitted to our medical intensive care unit (ICU), neuroscience ICU or haematologic/oncologic ICU between 2007 and 2011.Patients who were transferred into an ICU while receiving therapy or who continued therapy after discharge from the ICU were included in the analysis. Results: A total of 118 consecutive patients were included in the study. Fifty-nine patients received IVIG. Twenty of these patients (34%) developed renal failure during the hospitalisation, including 15 (25.4%) in whom renal function worsened during or shortly after IVIG administration and 4 (6.8%) in whom IVIG was considered a possible cause. Transfusion reactions occurred in five patients (8%). Seven patients (12%) did not receive the full intended course of IVIG. Thirty-four patients (58%) who received IVIG died during their hospitalisation. Fifty-nine patients received PLEX. Hypotension requiring an intervention was noted with 39 sessions (8.5%) and led to discontinuation of the session in 11 (2.4%). Other adverse events included line-related infections (n=4), pneumothorax (n=4) and electrolyte abnormalities and transfusion reactions (n=10). Six patients (10%) did not receive full intended treatment course of PLEX. Nineteen patients (32%) treated with PLEX died during their hospitalisation. Discussion: Intravenous immunoglobulin and PLEX are generally well tolerated by critically ill patients. Intravenous immunoglobulin was associated with worsening renal function in one-quarter of patients.

KW - Adverse events

KW - Critical care

KW - Intensive care unit

KW - Intravenous immunoglobulin

KW - Plasma exchange

KW - Safety

UR - http://www.scopus.com/inward/record.url?scp=84930430433&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930430433&partnerID=8YFLogxK

U2 - 10.1179/1743132815Y.0000000017

DO - 10.1179/1743132815Y.0000000017

M3 - Article

C2 - 25751423

AN - SCOPUS:84930430433

VL - 37

SP - 593

EP - 598

JO - Neurological Research

JF - Neurological Research

SN - 0161-6412

IS - 7

ER -