Abstract Details

Title Shorter vs Longer High-dose IVIG Courses in Hospitalized Neurology Patients: Implications for Safety and Length-of-Stay

Topic Neurohospitalist

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 2-012

Objective (1) Compare adverse events (AEs) between ≤3-day (Group A) and >3-day (Group B) IVIG courses, and (2) examine the effect of dosing strategy on hospital length of stay (LOS).

Background High-dose intravenous immunoglobulin (IVIG, 2 g/kg) is typically administered over 2–5 days for acute neurologic indications. However, clinicians often default to a 5-day course, which may prolong hospitalization without a proven safety advantage.

Design/Methods We conducted a retrospective observational study of adults (≥18 years) admitted across the NYU Langone Health system from 2013–2023 who received a total IVIG dose of 2 g/kg for neurologic indications. Data abstracted included demographics, comorbidities, dosing scalar, AEs, and LOS. Between-group comparisons and multivariable models adjusted for comorbidities were used to identify independent predictors of AEs and LOS.

Results Among 366 eligible patients, 137 (37%) received IVIG over ≤3 days and 229 (63%) over >3 days; 48.6% were dosed by actual body weight. LOS was significantly longer with >3-day courses, exceeding ≤3-day courses by ~5 days (95% CI, 2.06–7.81). Histories of thrombosis and anemia were independently associated with longer LOS. Overall, AE rates were comparable between shorter and longer courses. Indication for IVIG was not associated with LOS or AEs. Dosing by actual versus ideal body weight did not influence AE rates. In adjusted analyses, chronic obstructive pulmonary disease (COPD) was the only comorbidity that significantly predicted AEs.

Conclusions

In hospitalized neurology patients receiving 2 g/kg IVIG, extending infusion beyond three days does not reduce AEs but is associated with substantially longer LOS (approximately five additional days). Dosing by actual versus ideal body weight did not impact AE rates. Consider IVIG courses for three days or fewer when appropriate. Thrombosis and anemia may result in longer hospitalizations, whereas COPD is associated with increased AE risk.

Authors/Disclosures
Nicole Zougheib, DO, MBA (Rowan-Virtua SOM) PRESENTER	Dr. Zougheib has nothing to disclose.
Bavica Gummadi, DO (NYU Langone)	Dr. Gummadi has nothing to disclose.
Patrick M. Kwon, MD	Dr. Kwon has nothing to disclose.
Marawon M. Elsayed, Sr., Undergraduate	Mr. Elsayed has nothing to disclose.
Aaron Lord, MD (NYU Langone-Brooklyn)	Dr. Lord has nothing to disclose.
Nada G. Abou Fayssal, MD, FAAN (NYU Langone Brooklyn Campus)	Dr. Abou Fayssal has nothing to disclose.
Ting Zhou, MD (New York University Langone Health - Brooklyn)	Dr. Zhou has nothing to disclose.
Leah P. Dickstein, MD (Johns Hopkins Hospital)	Dr. Dickstein has nothing to disclose.

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