Clin Transl Immunology . Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID-19: a multicenter retrospective cohort study

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Clin Transl Immunology


. 2020 Oct 14;9(10):e1192.
doi: 10.1002/cti2.1192. eCollection 2020.
Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID-19: a multicenter retrospective cohort study


Ziyun Shao ¹ , Yongwen Feng ^{2 3} , Li Zhong ⁴ , Qifeng Xie ⁵ , Ming Lei ⁶ , Zheying Liu ⁵ , Conglin Wang ⁵ , Jingjing Ji ⁵ , Huiheng Liu ⁷ , Zhengtao Gu ⁸ , Zhongwei Hu ⁶ , Lei Su ⁵ , Ming Wu ^{2 5} , Zhifeng Liu ^{5 9}



Affiliations

• PMID: 33082954
• PMCID: PMC7557105
• DOI: 10.1002/cti2.1192

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.

Keywords: COVID‐19; IVIG; SARS‐CoV‐2; clinical efficacy; mortality.