Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study
Abstract Objective Coronavirus disease 2019 (COVID‐19) outbreak is a major challenge all over the world, without acknowledged treatment. Intravenous immunoglobulin (IVIG) has been recommended to treat critical coronavirus disease 2019 (COVID‐19) patients in a few reviews, but the clinical study evid...
Main Authors: | , , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Wiley
2020-01-01
|
Series: | Clinical & Translational Immunology |
Subjects: | |
Online Access: | https://doi.org/10.1002/cti2.1192 |
id |
doaj-373f944ca81149b2bdc4a7b415d3d76b |
---|---|
record_format |
Article |
spelling |
doaj-373f944ca81149b2bdc4a7b415d3d76b2020-11-25T03:44:12ZengWileyClinical & Translational Immunology2050-00682020-01-01910n/an/a10.1002/cti2.1192Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort studyZiyun Shao0Yongwen Feng1Li Zhong2Qifeng Xie3Ming Lei4Zheying Liu5Conglin Wang6Jingjing Ji7Huiheng Liu8Zhengtao Gu9Zhongwei Hu10Lei Su11Ming Wu12Zhifeng Liu13Department of Nephrology General Hospital of Central Theater Command of PLA Wuhan430070ChinaDepartment of Critical Care Medicine and Hospital Infection Prevention and Control The Second People’s Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University Health Science Center Shenzhen518035ChinaDepartment of Critical Care Medicine The First Affiliated Hospital Guizhou University of Chinese Medicine Guiyang550001ChinaDepartment of Critical Care Medicine General Hospital of Southern Theater Command of PLA Guangzhou510010ChinaDepartment of Nephrology Guangzhou Eighth people's hospital Guangzhou Medical University Guangzhou510060ChinaDepartment of Critical Care Medicine General Hospital of Southern Theater Command of PLA Guangzhou510010ChinaDepartment of Critical Care Medicine General Hospital of Southern Theater Command of PLA Guangzhou510010ChinaDepartment of Critical Care Medicine General Hospital of Southern Theater Command of PLA Guangzhou510010ChinaDepartment of Emergency Zhongshan Hospital of Xiamen University Xiamen361000ChinaDepartment of Treatment Center for Traumatic Injuries The Third Affiliated Hospital Academy of Orthopedics Guangdong Province Southern Medical University Guangzhou Guangdong515630ChinaDepartment of Nephrology Guangzhou Eighth people's hospital Guangzhou Medical University Guangzhou510060ChinaDepartment of Critical Care Medicine General Hospital of Southern Theater Command of PLA Guangzhou510010ChinaDepartment of Critical Care Medicine and Hospital Infection Prevention and Control The Second People’s Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University Health Science Center Shenzhen518035ChinaDepartment of Critical Care Medicine General Hospital of Southern Theater Command of PLA Guangzhou510010ChinaAbstract Objective Coronavirus disease 2019 (COVID‐19) outbreak is a major challenge all over the world, without acknowledged treatment. Intravenous immunoglobulin (IVIG) has been recommended to treat critical coronavirus disease 2019 (COVID‐19) patients in a few reviews, but the clinical study evidence on its efficacy in COVID‐19 patients was lacking. Methods 325 patients with laboratory‐confirmed critical COVID‐19 were enrolled from 4 government‐designated COVID‐19 treatment centres in southern China from December 2019 to March 2020. The primary outcomes were 28‐ and 60‐day mortality, and the secondary outcomes were the total length of in‐hospital and the total duration of the disease. Subgroup analysis was carried out according to clinical classification of COVID‐19, IVIG dosage and timing. Results In the enrolled 325 patients, 174 cases used IVIG and 151 cases did not. The 28‐day mortality was improved with IVIG after adjusting confounding in overall cohort (P = 0.0014), and the in‐hospital and the total duration of disease were longer in the IVIG group (P < 0.001). Subgroup analysis showed that only in patients with critical type, IVIG could significantly reduce the 28‐day mortality, decrease the inflammatory response and improve some organ functions (all P < 0.05); the application of IVIG in the early stage (admission ≤ 7 days) with a high dose (> 15 g per day) exhibited significant reduction in 60‐day mortality in the critical‐type patients. Conclusion Early administration of IVIG with high dose improves the prognosis of critical‐type patients with COVID‐19. This study provides important information on clinical application of IVIG in the treatment of SARS‐CoV‐2 infection, including patient selection and administration dosage and timing.https://doi.org/10.1002/cti2.1192SARS‐CoV‐2COVID‐19IVIGclinical efficacymortality |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ziyun Shao Yongwen Feng Li Zhong Qifeng Xie Ming Lei Zheying Liu Conglin Wang Jingjing Ji Huiheng Liu Zhengtao Gu Zhongwei Hu Lei Su Ming Wu Zhifeng Liu |
spellingShingle |
Ziyun Shao Yongwen Feng Li Zhong Qifeng Xie Ming Lei Zheying Liu Conglin Wang Jingjing Ji Huiheng Liu Zhengtao Gu Zhongwei Hu Lei Su Ming Wu Zhifeng Liu Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study Clinical & Translational Immunology SARS‐CoV‐2 COVID‐19 IVIG clinical efficacy mortality |
author_facet |
Ziyun Shao Yongwen Feng Li Zhong Qifeng Xie Ming Lei Zheying Liu Conglin Wang Jingjing Ji Huiheng Liu Zhengtao Gu Zhongwei Hu Lei Su Ming Wu Zhifeng Liu |
author_sort |
Ziyun Shao |
title |
Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study |
title_short |
Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study |
title_full |
Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study |
title_fullStr |
Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study |
title_full_unstemmed |
Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study |
title_sort |
clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with covid‐19: a multicenter retrospective cohort study |
publisher |
Wiley |
series |
Clinical & Translational Immunology |
issn |
2050-0068 |
publishDate |
2020-01-01 |
description |
Abstract Objective Coronavirus disease 2019 (COVID‐19) outbreak is a major challenge all over the world, without acknowledged treatment. Intravenous immunoglobulin (IVIG) has been recommended to treat critical coronavirus disease 2019 (COVID‐19) patients in a few reviews, but the clinical study evidence on its efficacy in COVID‐19 patients was lacking. Methods 325 patients with laboratory‐confirmed critical COVID‐19 were enrolled from 4 government‐designated COVID‐19 treatment centres in southern China from December 2019 to March 2020. The primary outcomes were 28‐ and 60‐day mortality, and the secondary outcomes were the total length of in‐hospital and the total duration of the disease. Subgroup analysis was carried out according to clinical classification of COVID‐19, IVIG dosage and timing. Results In the enrolled 325 patients, 174 cases used IVIG and 151 cases did not. The 28‐day mortality was improved with IVIG after adjusting confounding in overall cohort (P = 0.0014), and the in‐hospital and the total duration of disease were longer in the IVIG group (P < 0.001). Subgroup analysis showed that only in patients with critical type, IVIG could significantly reduce the 28‐day mortality, decrease the inflammatory response and improve some organ functions (all P < 0.05); the application of IVIG in the early stage (admission ≤ 7 days) with a high dose (> 15 g per day) exhibited significant reduction in 60‐day mortality in the critical‐type patients. Conclusion Early administration of IVIG with high dose improves the prognosis of critical‐type patients with COVID‐19. This study provides important information on clinical application of IVIG in the treatment of SARS‐CoV‐2 infection, including patient selection and administration dosage and timing. |
topic |
SARS‐CoV‐2 COVID‐19 IVIG clinical efficacy mortality |
url |
https://doi.org/10.1002/cti2.1192 |
work_keys_str_mv |
AT ziyunshao clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT yongwenfeng clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT lizhong clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT qifengxie clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT minglei clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT zheyingliu clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT conglinwang clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT jingjingji clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT huihengliu clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT zhengtaogu clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT zhongweihu clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT leisu clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT mingwu clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy AT zhifengliu clinicalefficacyofintravenousimmunoglobulintherapyincriticalillpatientswithcovid19amulticenterretrospectivecohortstudy |
_version_ |
1724515575013572608 |