Use of intravenous immune globulin in the ICU: a retrospective review of prescribing practices and patient outcomes

Foster, Ryan W.; Suri, Amit; Filate, Woganee A; Hallett, David; Meyer, Jason; Ruijs, Theodora; Callum, Jeannie; Sutton, Diana Lee; Mehta, Sangeeta

doi:10.1111/j.1365-3148.2010.01022.x

Cited by 28 publications

(35 citation statements)

References 16 publications

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“…Our study observed a relatively high overall same‐day TE incidence rate of 1%, with rates ranging up to 2% for specific products, which was consistent with existing literature showing TE rates from 0.6% to 5% after IG exposure 2,4,11,12,39‐43 . The study results showed that venous same‐day TEs were more common than arterial TEs.…”

Section: Discussionsupporting

confidence: 91%

Immune globulins and thrombotic adverse events as recorded in a large administrative database in 2008 through 2010

et al. 2012

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BACKGROUND: Thrombotic events (TEs) are rare but often serious adverse events that could occur after administration of immune globulin (IG) products. Our study objective was to assess occurrence of recorded TEs after administration of different US‐licensed IG products and investigate potential risk factors using a large administrative database. STUDY DESIGN AND METHODS: This is a retrospective claims‐based cohort study of individuals exposed to IG products from January 1, 2008, through September 30, 2010, using HealthCore's Integrated Research Database, a longitudinal health care database. IG products were identified by recorded Healthcare Common Procedure Coding System codes. TEs were ascertained via International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for same‐day TEs by IG product, while controlling for confounders. RESULTS: Of 11,785 individuals exposed to IG products in the study period, 122 (1%) had TE(s) recorded on the same day as IG administration. TE rates per 1000 persons exposed ranged from 6.1 to 20.5 for different IG product groups. Vivaglobin users had an increased same‐day TE risk compared to reference Gammagard Liquid users (OR, 3.56; 95% CI, 1.54‐8.23). An increased TE risk was also found with older age (≥45 years), prior TE(s), and hypercoagulable state(s). CONCLUSION: The study suggests potentially elevated TE rates for different IG products, including subcutaneous. It also identifies important recipient TE risk factors and suggests that risk–benefit profiles should be weighed before IG administration. The observed differences may be due to various factors such as dosage, administration rates, and product manufacturing processes that warrant further evaluation.

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Section: Discussionsupporting

confidence: 91%

Immune globulins and thrombotic adverse events as recorded in a large administrative database in 2008 through 2010

et al. 2012

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“…A study of IVIG use in an adult ICU revealed 19% of IVIG prescriptions were for 'appropriate' indications and 7% were 'inappropriate'. The remaining 74% were prescribed for indications with some evidence to support their use 10 . In this study GBS was a common indication despite the presence of other therapeutic alternatives .A study reported that , in children with GBS requiring mechanical ventilation, Plasmapaharesis was superior to IVIG regarding the duration of Mechanical ventilation but not PICU stay or the short term neurological outcome 11 .…”

Section: Discussionmentioning

confidence: 99%

Pattern of intravenous immunoglobulins (IVIG) use in a pediatric intensive care facility in a resource limited setting

Galal¹

2013

Afr H. Sci.

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Background: Intravenous Immunoglobulin (IVIG) preparations are scarce biological products used for replacement or immunomodulatory effects. Guidelines have been issued by regulatory health authorities to ensure provision of the products for patients who are in severe need. Objectives: The study aimed at description of the pattern of IVIG use (label/off label indications), adverse effects observed, reason for choice of IVIG among other modalities and efficacy in a pediatric intensive care setting. Methods: A retrospective chart review. Patients: The study included 45 cases admitted from 2008 through 2011 in a Pediatric Intensive Care Unit (PICU) of a tertiary referral pediatric hospital. Results: The clinical diagnoses included neurology (35%), neonatology (16%), hematology (11%), autoimmune disorders (11%) immunodeficiency disorders (11%), infections other than neonatal sepsis (9%) and cardiology (6.5 %). The indications for IVIG use had an Evidence category Ia / Ib in 62 % of cases whereas the other 38 % had level II and III evidence. Choice of IVIG as a therapeutic option was based on failure of other treatment options to achieve response in 46.5%, lack of alternative treatment options 15.5 % and the need for urgent response in 38 %. Adverse events, duration and doses are reported. Conclusion: IVIG use is governed by availability of alternative options and the need for urgent response in critically ill children. Guidelines should be issued based on locally available treatment options and their cost effectiveness.

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“…Intravenous Ig is well tolerated in people, with less than 5% of patients suffering from adverse effects after transfusion . The most common side effect of hIVIG use is acute hypersensitivity; other reported complications include thromboembolism, renal failure, hypotension, aseptic meningitis, and fluid overload . Veterinary patients exposed to hIVIG are at risk for these same complications, but carry a higher risk of reaction as hIVIG administration involves xenoprotein introduction to the body.…”

Section: Adverse Effects Of Ivig Administrationmentioning

confidence: 99%

“…Thromboembolic events including deep vein thrombosis, myocardial infarction, pulmonary embolism, central retinal vein occlusion, cerebro‐vascular accidents, and hepatic veno‐occlusive disease have been reported in people following hIVIG transfusion . A 2009 study by Tsuchiya et al revealed increased concentrations of circulating thrombin‐antithrombin complexes and fibrinogen degradation products in healthy beagles receiving human Ig, and concluded that hIVIG administration promotes hypercoagulability in dogs .…”

Section: Hypercoagulationmentioning

confidence: 99%

A review of current indications, adverse effects, and administration recommendations for intravenous immunoglobulin

Spurlock

Prittie²

2011

J Vet Emergen Crit Care

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Immunoglobulin (Ig) has not been shown to decrease transfusion requirements in IMHA patients, but shows great promise for treatment of ITP and dermatological diseases. Although serial transfusion of hIVIG is employed in human medicine, repeated transfusion is not recommended in animals due to risk of severe allergic reaction. Other potential adverse effects of transfusion include delayed hypersensitivity reactions, thromboembolism, renal failure, hypotension, and aseptic meningitis.

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Use of intravenous immune globulin in the ICU: a retrospective review of prescribing practices and patient outcomes

Abstract: IVIG is used relatively infrequently in the critical care setting. The most common indications were GBS, TEN and NF. Mortality was high. There was no difference between community and academic ICUs.

Cited by 28 publications

References 16 publications

Immune globulins and thrombotic adverse events as recorded in a large administrative database in 2008 through 2010

Immune globulins and thrombotic adverse events as recorded in a large administrative database in 2008 through 2010

Pattern of intravenous immunoglobulins (IVIG) use in a pediatric intensive care facility in a resource limited setting

A review of current indications, adverse effects, and administration recommendations for intravenous immunoglobulin

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