Intravenous Immunoglobulin in Children with Streptococcal Toxic Shock Syndrome
Intravenous Immunoglobulin in Children with Streptococcal Toxic Shock Syndrome
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DOI：
10.1086/606048
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发表时间：
2009-11-01
影响因子：
11.8
通讯作者：
Levin, James E.
中科院分区：
文献类型：
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作者：
Shah, Samir S.;Hall, Matthew;Levin, James E.
背景链球菌中毒性休克综合征（TSS）是A组链球菌感染的一种罕见而严重的表现。静脉注射免疫球蛋白（IVIG）对儿童链球菌TSS的作用是有争议的。本研究旨在描述儿童链球菌TSS的流行病学，并确定IVIG连续治疗是否与改善结局相关。对2003年1月1日至2007年12月31日患有链球菌TSS的儿童进行了一项多中心、回顾性队列研究。倾向评分用于确定每个儿童接受IVIG的可能性。在IVIG接受者和非接受者的倾向评分匹配后，比较主要结局的死亡、住院时间和总住院费用的差异。患者年龄中位数为8.2岁。192例患者中有84例（44%）接受了IVIG治疗。总死亡率为4.2%（95%置信区间，1.8%-8.0%）。IVIG接受者（n = 3; 4.5%）和非接受者（n = 3; 4.5%）之间的死亡率差异无统计学意义（P> 0.99）。虽然接受IVIG的患者的总住院费用和药物费用高于未接受IVIG的患者，但一旦去除药物费用，住院费用的差异并不显著（匹配患者之间的中位数差异为6139美元;四分位数范围为-8316至25,993美元; P = 0.06）。IVIG匹配者与非匹配者的住院时间无差异。据我们所知，这项多中心研究是描述链球菌TSS儿童流行病学和结局的最大规模研究，也是第一个探索IVIG使用与临床结局之间关系的研究。IVIG的使用与链球菌TSS患儿的护理费用增加有关，但与结局改善无关。
Background. Streptococcal toxic shock syndrome (TSS) is a rare and severe manifestation of group A streptococcal infection. The role of intravenous immunoglobulin (IVIG) for streptococcal TSS in children is controversial. This study aims to describe the epidemiology of streptococcal TSS in children and to determine whether adjunctive therapy with IVIG is associated with improved outcomes.Methods. A multicenter, retrospective cohort study of children with streptococcal TSS from 1 January 2003 through 31 December 2007 was conducted. Propensity scores were used to determine each child's likelihood of receiving IVIG. Differences in the primary outcomes of death, hospital length of stay, and total hospital costs were compared after matching IVIG recipients and nonrecipients on propensity score.Results. The median patient age was 8.2 years. IVIG was administered to 84 (44%) of 192 patients. The overall mortality rate was 4.2% (95% confidence interval, 1.8%-8.0%). Differences in mortality between IVIG recipients (n = 3; 4.5%) and nonrecipients (n = 3; 4.5%) were not statistically significant (P>.99). Although patients receiving IVIG had higher total hospital and drug costs than nonrecipients, differences in hospital costs were not significant once drug costs were removed (median difference between matched patients, $6139; interquartile range, -$8316 to $25,993; P = .06). No differences were found in length of hospital stay between matched IVIG recipients and nonrecipients.Conclusion. This multicenter study is, to our knowledge, the largest to describe the epidemiology and outcomes of children with streptococcal TSS and the first to explore the association between IVIG use and clinical outcomes. IVIG use was associated with increased costs of caring for children with streptococcal TSS but was not associated with improved outcomes.