• Takashi Tagami, Hiroki Matsui, Kiyohide Fushimi, and Hideo Yasunaga.
• Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo Department of Emergency and Critical Care Medicine, Nippon Medical School.
• Clin. Infect. Dis. 2015 Aug 1; 61 (3): 385-92.

BackgroundThe role of intravenous immunoglobulin (IVIG) as an adjunctive treatment for severe sepsis remains controversial. We hypothesized that IVIG could be effective for treating pneumonia patients who have septic shock.MethodsMechanically ventilated pneumonia patients with septic shock were identified in the nationwide Japanese Diagnosis Procedure Combination inpatient database from 1 July 2010 to 31 March 2013. The effect of IVIG use on 28-day mortality was evaluated using propensity score and instrumental variable analyses.ResultsEligible patients (n = 8264) from 1014 hospitals were divided into an IVIG group (n = 1324) and a control group (n = 6940). Propensity score matching created a matched cohort of 1045 pairs with and without IVIG treatment. There was no significant difference in 28-day mortality between the IVIG and control groups in the unmatched analysis (37.8%, 501/1324 vs 35.3%, 2453/6940; difference, 2.5%; 95% confidence interval [CI], -.3 to 5.3) or the propensity score-matched analysis (36.7%, 383/1045 vs 36.0%, 376/1045; difference, 0.7%; 95% CI, -3.5 to 4.8). Logistic regression analysis did not show a significant association between IVIG use and 28-day mortality in propensity score-matched patients (1.03; 95% CI, .86 to 1.23). Analysis using the pattern of hospital IVIG use as an instrumental variable found that IVIG use was not associated with a reduction in 28-day mortality (difference, -3.1%; 95% CI, -13.2 to 7.0).ConclusionsIn this large retrospective nationwide study, we found that there may be no significant association between IVIG use and mortality in mechanically ventilated pneumonia patients with septic shock.© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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