Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study

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 i...

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Published in:Clinical & Translational Immunology 2020, Vol.9 (10), p.e1192-n/a
Main Authors: Shao, Ziyun, Feng, Yongwen, Zhong, Li, Xie, Qifeng, Lei, Ming, Liu, Zheying, Wang, Conglin, Ji, Jingjing, Liu, Huiheng, Gu, Zhengtao, Hu, Zhongwei, Su, Lei, Wu, Ming, Liu, Zhifeng
Format: Article
Language:English
Subjects:
Age
Blood pressure
Cardiovascular disease
clinical efficacy
Cohort analysis
Comorbidity
Coronaviruses
COVID-19
Demographics
Diabetes
Dosage
Hypertension
Immunoglobulins
Infections
Inflammation
Intravenous administration
IVIG
Laboratories
Lymphocytes
Medical prognosis
Medical research
Mortality
Original
Patients
Physiology
Proteins
SARS‐CoV‐2
Severe acute respiratory syndrome coronavirus 2
Viral infections
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container_title Clinical & Translational Immunology
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creator Shao, Ziyun
Feng, Yongwen
Zhong, Li
Xie, Qifeng
Lei, Ming
Liu, Zheying
Wang, Conglin
Ji, Jingjing
Liu, Huiheng
Gu, Zhengtao
Hu, Zhongwei
Su, Lei
Wu, Ming
Liu, Zhifeng
description 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 
doi_str_mv 10.1002/cti2.1192
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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 &lt; 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 &lt; 0.05); the application of IVIG in the early stage (admission ≤ 7 days) with a high dose (&gt; 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. Early administration of a high dose of intravenous immunoglobulin (IVIG) 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.</description><identifier>ISSN: 2050-0068</identifier><identifier>EISSN: 2050-0068</identifier><identifier>DOI: 10.1002/cti2.1192</identifier><identifier>PMID: 33082954</identifier><language>eng</language><publisher>Australia: John Wiley &amp; Sons, Inc</publisher><subject>Age ; Blood pressure ; Cardiovascular disease ; clinical efficacy ; Cohort analysis ; Comorbidity ; Coronaviruses ; COVID-19 ; Demographics ; Diabetes ; Dosage ; Hypertension ; Immunoglobulins ; Infections ; Inflammation ; Intravenous administration ; IVIG ; Laboratories ; Lymphocytes ; Medical prognosis ; Medical research ; Mortality ; Original ; Patients ; Physiology ; Proteins ; SARS‐CoV‐2 ; Severe acute respiratory syndrome coronavirus 2 ; Viral infections</subject><ispartof>Clinical &amp; Translational Immunology, 2020, Vol.9 (10), p.e1192-n/a</ispartof><rights>2020 The Authors. published by John Wiley &amp; Sons Australia, Ltd on behalf of Australian and New Zealand Society for Immunology, Inc.</rights><rights>2020 The Authors. Clinical &amp; Translational Immunology published by John Wiley &amp; Sons Australia, Ltd on behalf of Australian and New Zealand Society for Immunology, Inc.</rights><rights>2020. This work is published under http://creativecommons.org/licenses/by/4.0 (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5372-737a6e77110db51903c07c77ecd9ec87bcfe6288fbb346a24fd33c7a20adf0553</citedby><cites>FETCH-LOGICAL-c5372-737a6e77110db51903c07c77ecd9ec87bcfe6288fbb346a24fd33c7a20adf0553</cites><orcidid>0000-0001-6273-1667</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2454982572/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2451292204?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,724,777,781,882,4010,11543,25734,27904,27905,27906,36993,36994,38497,43876,44571,46033,46457,53772,53774,74161,74875</link.rule.ids><linktorsrc>$$Uhttps://www.proquest.com/docview/2451292204?pq-origsite=primo$$EView_record_in_ProQuest$$FView_record_in_$$GProQuest</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33082954$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shao, Ziyun</creatorcontrib><creatorcontrib>Feng, Yongwen</creatorcontrib><creatorcontrib>Zhong, Li</creatorcontrib><creatorcontrib>Xie, Qifeng</creatorcontrib><creatorcontrib>Lei, Ming</creatorcontrib><creatorcontrib>Liu, Zheying</creatorcontrib><creatorcontrib>Wang, Conglin</creatorcontrib><creatorcontrib>Ji, Jingjing</creatorcontrib><creatorcontrib>Liu, Huiheng</creatorcontrib><creatorcontrib>Gu, Zhengtao</creatorcontrib><creatorcontrib>Hu, Zhongwei</creatorcontrib><creatorcontrib>Su, Lei</creatorcontrib><creatorcontrib>Wu, Ming</creatorcontrib><creatorcontrib>Liu, Zhifeng</creatorcontrib><title>Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study</title><title>Clinical &amp; Translational Immunology</title><addtitle>Clin Transl Immunology</addtitle><description>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 &lt; 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 &lt; 0.05); the application of IVIG in the early stage (admission ≤ 7 days) with a high dose (&gt; 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. Early administration of a high dose of intravenous immunoglobulin (IVIG) improves the prognosis of critical‐type patients with COVID‐19. 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Translational Immunology</jtitle><addtitle>Clin Transl Immunology</addtitle><date>2020</date><risdate>2020</risdate><volume>9</volume><issue>10</issue><spage>e1192</spage><epage>n/a</epage><pages>e1192-n/a</pages><issn>2050-0068</issn><eissn>2050-0068</eissn><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 &lt; 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 &lt; 0.05); the application of IVIG in the early stage (admission ≤ 7 days) with a high dose (&gt; 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. Early administration of a high dose of intravenous immunoglobulin (IVIG) 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.</abstract><cop>Australia</cop><pub>John Wiley &amp; Sons, Inc</pub><pmid>33082954</pmid><doi>10.1002/cti2.1192</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-6273-1667</orcidid><oa>free_for_read</oa></addata></record>
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subjects Age
Blood pressure
Cardiovascular disease
clinical efficacy
Cohort analysis
Comorbidity
Coronaviruses
COVID-19
Demographics
Diabetes
Dosage
Hypertension
Immunoglobulins
Infections
Inflammation
Intravenous administration
IVIG
Laboratories
Lymphocytes
Medical prognosis
Medical research
Mortality
Original
Patients
Physiology
Proteins
SARS‐CoV‐2
Severe acute respiratory syndrome coronavirus 2
Viral infections
title Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: a multicenter retrospective cohort study
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