Torbic Heather, Abdul-Wahab Sinan Samir, Ennala Sravanthi, Guduguntla Nagamani, Han Xiaozhen, Wang Xiaofeng, Duggal Abhijit, Krishnan Sudhir
Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
Department of Internal Medicine, Mountainview Regional Medical Center, Las Cruces, New Mexico.
Crit Care Explor. 2021 Jan 11;3(1):e0314. doi: 10.1097/CCE.0000000000000314. eCollection 2021 Jan.
Previous literature has not compared prescribing practices of IV immunoglobulin in medical ICU survivors and nonsurvivors. The objective of this study was to study IV immunoglobulin use in patients admitted to a medical ICU evaluating differences between hospital survivors and nonsurvivors in regards to level of evidence supporting use, prescribing patterns, and cost.
Retrospective, observational study.
Single, academic medical center medical ICU.
Adults who received greater than or equal to 1 dose of IV immunoglobulin during their medical ICU admission from 2011 to 2018.
Prescribing patterns, level of evidence supporting use, and cost.
A total of 389 patients received greater than or equal to 1 dose of IV immunoglobulin for 46 discrete indications and 36.5% of indications had low-quality data supporting use of IV immunoglobulin. The primary indication for IV immunoglobulin was hypogammaglobulinemia (35.5%) followed by antibody-mediated lung transplant rejection (15.4%). Nonsurvivors received lower median dosing (g/kg) and number of doses compared with survivors (0.4 g/kg [0.4-1 g/kg] vs 0.5 g/kg [0.4-1 g/kg] [ = 0.0003] and 1.0 [1-2] vs 2 [1-3] doses [ = 0.0001], respectively). Dosing was based on ideal body weight in 258 patients (66%). High-quality data supported IV immunoglobulin use in 15 patients (4%). The median cost per dose of IV immunoglobulin in nonsurvivors was $4,893 ($4,078-$8,155) versus $5,709 ($4,078-$10,602) in survivors ( = 0.04).
IV immunoglobulin is prescribed for many indications in the medical ICU with low-quality evidence supporting its use and dosing regimens are variable. Hospital survivors received a higher dose and greater number of doses of IV immunoglobulin compared with nonsurvivors. National guidelines are needed to help inform IV immunoglobulin utilization and reduce healthcare costs.
既往文献未比较医疗重症监护病房（ICU）幸存者与非幸存者静脉注射免疫球蛋白的用药情况。本研究的目的是研究入住医疗ICU的患者使用静脉注射免疫球蛋白的情况，评估医院幸存者与非幸存者在支持使用的证据水平、用药模式和费用方面的差异。
回顾性观察研究。
单一的学术医疗中心的医疗ICU。
2011年至2018年在医疗ICU住院期间接受≥1剂静脉注射免疫球蛋白的成年人。
用药模式、支持使用的证据水平和费用。
共有389例患者因46种不同适应证接受≥1剂静脉注射免疫球蛋白，36.5%的适应证支持使用静脉注射免疫球蛋白的数据质量较低。静脉注射免疫球蛋白的主要适应证是低丙种球蛋白血症（35.5%），其次是抗体介导的肺移植排斥反应（15.4%）。与幸存者相比，非幸存者接受的中位剂量（克/千克）和剂量数较低（分别为0.4克/千克[0.4 - 1克/千克]对0.5克/千克[0.4 - 1克/千克][P = 0.0003]和1.0[1 - 2]剂对2[1 - 3]剂[P = 0.0001]）。258例患者（66%）的剂量是根据理想体重计算的。高质量数据支持15例患者（4%）使用静脉注射免疫球蛋白。非幸存者静脉注射免疫球蛋白每剂的中位费用为4893美元（4078 - 8155美元），而幸存者为5709美元（4078 - 10602美元）（P = 0.04）。
在医疗ICU中，静脉注射免疫球蛋白因多种适应证而被使用，但其使用的证据质量较低且用药方案存在差异。与非幸存者相比，医院幸存者接受的静脉注射免疫球蛋白剂量更高、剂量数更多。需要国家指南来指导静脉注射免疫球蛋白的使用并降低医疗费用。
