Effect of Intravenous Immunoglobulin Therapy for Streptococcal Toxic Shock Syndrome: A Japanese Nationwide Observational Study

Abstract

AbstractBackgroundStreptococcal toxic shock syndrome (STSS) is a rare but potentially fatal condition. Intravenous immunoglobulin (IVIG) treatment appears to reduce mortality; however, the clinical evidence remains controversial. Therefore, this study aimed to evaluate the effect of IVIG using a nationwide database by considering and adjusting for all background factors.MethodsThe treatment efficacy of IVIG in patients with STSS was investigated. Patient data were extracted from a Japanese nationwide database between April 2015 and March 2018. In-hospital mortality was considered the primary outcome, and 30-day and 7-day mortalities were considered secondary outcomes. Background adjustments were made using multivariate logistic analysis. For the sensitivity analysis, propensity score matching, time dependence of IVIG administration, and dose-response relationship were also assessed.ResultsOverall, 102 patients were included for the analysis. Their characteristics were as follows: median age, 62 years; female sex, 33.0% (34/102); overall mortality, 30.4% (31/102); necrotizing fasciitis patients, 57.8% (59/102); and IVIG-treated patients, 35.3% (36/102). After adjustment using multivariate logistic regression, no effect of IVIG treatment was observed on in-hospital mortality (adjusted odds ratio, [95% confidence interval (CI)]: 0.99 [0.90–1.08], p=0.88). This result was consistent with that after propensity score matching (odds ratio [95% CI]: 1.00 [0.34–2.92], p>0.99). Furthermore, IVIG treatment did not change the 30-day and 7-day mortalities. Neither the timing of IVIG administration nor IVIG dose had an effect on in-hospital mortality.ConclusionsThe administration of IVIG did not show any survival benefits.An equivalent or a more extensive observational study is warranted to confirm these findings.