Surawattanawong Totsapol, Hiransuthikul Akarin, Katasrila Panthicha, Hemachudha Thiravat, Saraya Abhinbhen W
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Asian Biomed (Res Rev News). 2025 Jul 28;19(3):147-153. doi: 10.2478/abm-2025-0018. eCollection 2025 Jun.
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.
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.
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.
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%, = 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, = 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.
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.
目前自身免疫性脑炎（AIE）急性期治疗的主流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，关于IVIG与PLEX在治疗相关并发症方面的风险和益处仍没有确凿证据。
本研究的主要目的是确定诊断为AIE并接受IVIG或PLEX治疗的患者医院获得性感染（HAIs）累积发生率的差异。次要目的是探讨住院时间和残疾程度的差异。
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、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）评估入院时和出院时的残疾程度。
在纳入研究的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%对50.0%，P = 0.03），住院时间显著缩短（中位数[四分位间距]12.0[6.0 - 23.0]天对25.0[21.0 - 49.0]天，P = 0.01）。原发性败血症是两组中最常见的感染原因。两组出院时的mRS、入院与出院之间mRS的变化以及住院总直接费用均无显著差异。
IVIG的使用与医院感染发生率降低相关，导致住院时间缩短并可能带来成本效益。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。
