Disclosures: Andrew K. Dang, BS: Nothing to disclose

Objective: Guillain-Barré syndrome (GBS) is an acute post-infectious demyelinating polyneuropathy characterized by symmetric and ascending flaccid paralysis. Standard therapy includes plasma exchange (PLEX), known as plasmapheresis, and intravenous immunoglobulin (IVIG). To date, neither PLEX nor IVIG has established superior clinical benefit. This study aims to further compare PLEX vs. IVIG for patients with GBS and concomitant DM.

Design: This retrospective cohort study utilized the Nationwide Inpatient Sample to identify patients (18+) from 2012-2015 diagnosed with GBS who underwent PLEX or IVIG. ICD-9 codes identified patients with DM and excluded patients missing identifiers (age, gender, death). Patients who received both PLEX and IVIG during the same hospitalization were excluded as combined treatment may affect outcomes. Data analyses assessed length of stay (LOS), total hospital charges, mortality and age of admission.

Setting: Nationwide Inpatient Sample Administrative Database, 2011-2015.

Participants: Patient encounters documented in Nationwide Inpatient Sample Database.

Interventions: Not applicable.

Main Outcome Measures: Mortality, total in-hospital charges, length of stay, age of admission

Results: Of the 2,472 patients receiving either PLEX or IVIG, 320 had DM without complications (120 underwent PLEX, 200 underwent IVIG), and 187 had DM with complications (84 underwent PLEX, 103 underwent IVIG). In comparison to patients who received IVIG, significant increases were observed in the PLEX group: DM without complications: • LOS (8.81 vs. 17.7 days, P<.0001) • Mortality (2.3% vs. 3.3%, P=.001) • Total charges ($127,081.89 vs. $194,006.43, P <.0001) DM with complications: • LOS (9.39 vs. 12.8 days, P=.0396) • Mortality (2.1% vs. 3.0%, P=.0097) • Total charges ($130,701.45 vs. $142,126.02, P=.036) No significant differences between IVIG vs. PLEX for age of admission in both DM patients with and without complications.

Conclusions: Patients with concomitant DM undergoing PLEX suffer from increased LOS, mortality, and total charges when compared to IVIG. Results of this study can aid clinicians in making treatment decisions within this population. Peri-procedural optimization of symptomatic patients is one potential avenue to improve patient outcomes.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/impact-of-diabetes-mellitus-on-short-term-in-hospital-outcomes-in-patients-with-guillain-barre-syndrome-undergoing-plasma-exchange-vs-intravenous-immunoglobulin-treatment/