Nörolojik Hastalıklarda İntravenöz İmmünoglobulin Tedavisinin Komplikasyonları

Abstract

This study aimed to evaluate the frequency, characteristics, and associated risk factors of adverse events, as well as long-term functional outcomes, in pediatric patients receiving intravenous immunoglobulin (IVIG) therapy for neurological indications. A retrospective analysis was conducted on 53 patients aged 1 month to 18 years who received IVIG at the Çukurova University Faculty of Medicine, Division of Pediatric Neurology, between January 1, 2018, and January 31, 2023. Demographic and clinical data, infusion characteristics, adverse events, and modified Rankin Scale (mRS) scores at admission, discharge, and the one-year follow-up were evaluated. A total of 427 IVIG courses and 1,708 infusions were administered to the patients. The mean age was 9.4 ± 5.3 years, and 58% of the patients were male. The most common indication was Guillain-Barré syndrome (74%). At least one adverse event occurred in 28% (n=15) of the patients. Most events were mild in severity; fever and headache were the most frequently observed, while thromboembolic events were detected in two patients. Among patients who experienced adverse events, 66.7% developed the event during the first course. The rate of adverse events was higher in patients receiving short-duration infusions (p<0.001). In multivariate logistic regression, infusion duration was the only significant independent predictor; the odds of developing an adverse event with a 4–6 hour infusion were approximately 78 times higher than with a 6–8 hour infusion (OR=78.20; 95% CI: 6.48–943.47; p<0.001). The rate of functional independence (mRS 0–2) was 21% at admission, 81% at discharge, and 94% at one year. Most IVIG-related adverse events were mild. The concentration of events during the first course and their association with short infusion duration support the individualization of infusion rates and close clinical monitoring, particularly during initial administrations.