tetano
Editor, Senior Moderator
Am J Physiol Lung Cell Mol Physiol
. 2020 Nov 25.
doi: 10.1152/ajplung.00359.2020. Online ahead of print.
Immunoglobulin Deficiency as an Indicator of Disease Severity in Patients with COVID-19
Faeq Husain-Syed[SUP] 1 [/SUP], Istv?n Vad?sz[SUP] 2 [/SUP], Jochen Wilhelm[SUP] 3 [/SUP], Hans-Dieter Walmrath[SUP] 4 [/SUP], Werner Seeger[SUP] 5 [/SUP], Horst-Walter Birk[SUP] 6 [/SUP], Birgit Jennert[SUP] 7 [/SUP], Hartmut Dietrich[SUP] 7 [/SUP], Susanne Herold[SUP] 8 [/SUP], Janina Trauth[SUP] 9 [/SUP], Khodr Tello[SUP] 5 [/SUP], Michael Sander[SUP] 10 [/SUP], Rory E Morty[SUP] 11 [/SUP], Heiko Slanina[SUP] 12 [/SUP], Christian G Sch?ttler[SUP] 12 [/SUP], John Ziebuhr[SUP] 13 [/SUP], Shadi Kassoumeh[SUP] 14 [/SUP], Claudio Ronco[SUP] 15 [/SUP], Fiorenza Ferrari[SUP] 16 [/SUP], Klaus Warnatz[SUP] 17 [/SUP], Klaus Stahl[SUP] 18 [/SUP], Benjamin Seeliger[SUP] 19 [/SUP], Marius M Hoeper[SUP] 20 [/SUP], Tobias Welte[SUP] 21 [/SUP], Sascha David[SUP] 22 [/SUP]
Affiliations
Abstract
Despite the pandemic status of COVID-19, there is limited information about host risk factors and treatment beyond supportive care. Immunoglobulin G (IgG) could be a potential treatment target. Our aim was to determine the incidence of IgG deficiency and associated risk factors in a cohort of 62 critical ill COVID-19 patients admitted to two German ICUs (72.6% male, median age: 61 years). 13 (21.0%) of the patients displayed IgG deficiency (IgG <7 g/L) at baseline (predominant for the IgG1, IgG2, and IgG4 subclasses). IgG-deficient patients had worse measures of clinical disease severity than those with normal IgG levels (shorter duration from disease onset to ICU admission, lower ratio of PaO[SUB]2[/SUB] to FiO[SUB]2[/SUB], higher Sequential Organ Failure Assessment score, and higher levels of ferritin, neutrophil-to-lymphocyte ratio and serum creatinine). IgG-deficient patients were also more likely to have sustained lower levels of lymphocyte counts and higher levels of ferritin throughout the hospital stay. Furthermore, IgG-deficient patients compared to those with normal IgG levels displayed higher rates of acute kidney injury (76.9% vs. 26.5%; p=0.005) and death (46.2% vs. 14.3%; p=0.012), longer ICU (28 [6-48] vs. 12 [3-18] days; p=0.012) and hospital length of stay (30 [22-50] vs. 18 [9-24] days; p=0.004). Multivariable logistic regression showed increasing odds of 90-day overall mortality associated with IgG-deficiency (OR 12.8, 95% CI 1.5-108.4; p=0.019). IgG deficiency might be common in critically ill COVID-19 patients, and warrants investigation as both a marker of disease severity as well as a potential therapeutic target.
Keywords: Cytokine release syndrome; Immunodysregulation; Respiratory failure; Severe acute respiratory syndrome coronavirus 2.
. 2020 Nov 25.
doi: 10.1152/ajplung.00359.2020. Online ahead of print.
Immunoglobulin Deficiency as an Indicator of Disease Severity in Patients with COVID-19
Faeq Husain-Syed[SUP] 1 [/SUP], Istv?n Vad?sz[SUP] 2 [/SUP], Jochen Wilhelm[SUP] 3 [/SUP], Hans-Dieter Walmrath[SUP] 4 [/SUP], Werner Seeger[SUP] 5 [/SUP], Horst-Walter Birk[SUP] 6 [/SUP], Birgit Jennert[SUP] 7 [/SUP], Hartmut Dietrich[SUP] 7 [/SUP], Susanne Herold[SUP] 8 [/SUP], Janina Trauth[SUP] 9 [/SUP], Khodr Tello[SUP] 5 [/SUP], Michael Sander[SUP] 10 [/SUP], Rory E Morty[SUP] 11 [/SUP], Heiko Slanina[SUP] 12 [/SUP], Christian G Sch?ttler[SUP] 12 [/SUP], John Ziebuhr[SUP] 13 [/SUP], Shadi Kassoumeh[SUP] 14 [/SUP], Claudio Ronco[SUP] 15 [/SUP], Fiorenza Ferrari[SUP] 16 [/SUP], Klaus Warnatz[SUP] 17 [/SUP], Klaus Stahl[SUP] 18 [/SUP], Benjamin Seeliger[SUP] 19 [/SUP], Marius M Hoeper[SUP] 20 [/SUP], Tobias Welte[SUP] 21 [/SUP], Sascha David[SUP] 22 [/SUP]
Affiliations
- PMID: 33237794
- DOI: 10.1152/ajplung.00359.2020
Abstract
Despite the pandemic status of COVID-19, there is limited information about host risk factors and treatment beyond supportive care. Immunoglobulin G (IgG) could be a potential treatment target. Our aim was to determine the incidence of IgG deficiency and associated risk factors in a cohort of 62 critical ill COVID-19 patients admitted to two German ICUs (72.6% male, median age: 61 years). 13 (21.0%) of the patients displayed IgG deficiency (IgG <7 g/L) at baseline (predominant for the IgG1, IgG2, and IgG4 subclasses). IgG-deficient patients had worse measures of clinical disease severity than those with normal IgG levels (shorter duration from disease onset to ICU admission, lower ratio of PaO[SUB]2[/SUB] to FiO[SUB]2[/SUB], higher Sequential Organ Failure Assessment score, and higher levels of ferritin, neutrophil-to-lymphocyte ratio and serum creatinine). IgG-deficient patients were also more likely to have sustained lower levels of lymphocyte counts and higher levels of ferritin throughout the hospital stay. Furthermore, IgG-deficient patients compared to those with normal IgG levels displayed higher rates of acute kidney injury (76.9% vs. 26.5%; p=0.005) and death (46.2% vs. 14.3%; p=0.012), longer ICU (28 [6-48] vs. 12 [3-18] days; p=0.012) and hospital length of stay (30 [22-50] vs. 18 [9-24] days; p=0.004). Multivariable logistic regression showed increasing odds of 90-day overall mortality associated with IgG-deficiency (OR 12.8, 95% CI 1.5-108.4; p=0.019). IgG deficiency might be common in critically ill COVID-19 patients, and warrants investigation as both a marker of disease severity as well as a potential therapeutic target.
Keywords: Cytokine release syndrome; Immunodysregulation; Respiratory failure; Severe acute respiratory syndrome coronavirus 2.