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 for symptomatic GBS include plasma exchange (PLEX), also known as plasmapheresis, and intravenous immunoglobulin (IVIG). Both have been found to be effective disease stabilizing therapies, but to date, neither PLEX nor IVIG has established superior clinical benefit. This study aims to compare PLEX vs. IVIG in patients with GBS who have concomitant rheumatoid arthritis (RA).

Design: This retrospective cohort study utilized the Nationwide Inpatient Sample to identify patients (18+) from 2012-2015 with a primary diagnosis of GBS undergoing PLEX or IVIG treatments. ICD-9 codes identified patients with RA and excluded patients missing identifiers (age, gender, death). Patients who received both PLEX and IVIG during the same hospitalization were also 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 the Nationwide Inpatient Sample Administrative Database.

Interventions: Not applicable.

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

Results: Of the 2,472 receiving either PLEX or IVIG, 227 patients had RA (161 underwent PLEX, 66 underwent IVIG). In comparison to patients who received IVIG, significant increases were observed in the PLEX group: • LOS (11.09 vs. 13.98 days, P <.0001) • Total charges ($149,151.86 vs. $209,553.75, P <.0001) • Mortality (3.0% vs. 8.1%, P <.0001) There were no significant differences between IVIG vs. PLEX for age of admission (61.48 vs. 65.79, P =.621).

Conclusions: Patients with RA who underwent PLEX suffer from increased LOS, mortality, and total charges when compared to IVIG. The results of this study can aid clinicians in making treatment decisions within this population. Limitations include inability to determine severity of RA or GBS. Peri-procedural optimization of symptomatic patients is one avenue to reduce LOS, total charges, mortality and improve patient outcomes.

Level of Evidence: Level I

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