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Intravenous immunoglobulin-based adjuvant therapy for severe COVID-19: a single-center retrospective cohort study

Xiao Hou¹, Li Tian², Lei Zhou³

¹Pelvic Floor Disease Center, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, Shandong, People's Republic of China.

Virology Journal

|May 22, 2021

Insights

Intravenous immunoglobulin (IVIG) did not improve outcomes for severe COVID-19 patients. This study suggests that immunoglobulin therapy is not beneficial for patients with severe coronavirus disease 2019.

Area of Science:

Critical Care Medicine
Infectious Diseases
Pharmacology

Background:

Coronavirus disease 2019 (COVID-19) presents a significant global health challenge.
Intravenous immunoglobulin (IVIG) is recommended in some guidelines for COVID-19 adjuvant therapy.
Clinical evidence supporting IVIG use in severe COVID-19 remains limited.

Purpose of the Study:

To evaluate the efficacy of IVIG as an adjuvant therapy in severe COVID-19 patients.
To assess the impact of IVIG on mortality, mechanical ventilation, and hospital stay.
To provide evidence regarding the use of immunoglobulin in severe COVID-19 cases.

Main Methods:

A single-center retrospective cohort study of adult patients with laboratory-confirmed severe COVID-19.
Inclusion criteria: adult patients with severe COVID-19.
Outcomes measured: composite endpoint (death or mechanical ventilation), length of hospital stay.

Main Results:

The IVIG group showed a higher composite endpoint rate (25.5% vs 7.6%) and longer hospital stays compared to the non-IVIG group.
After adjusting for confounding factors, the difference in primary outcomes was not statistically significant (P=0.167).
However, patients receiving IVIG had significantly longer hospital stays (P=0.041).

Conclusions:

Adjuvant IVIG therapy did not reduce in-hospital mortality or the need for mechanical ventilation in severe COVID-19 patients.
The study findings do not support the use of immunoglobulin in severe COVID-19 cases.
Further research may be needed to clarify the role of IVIG in specific COVID-19 patient subgroups.

Read full analysis

Abstract

Objective:

Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines issued by National Health Commission of the People's Repubilic of China recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG.

Methods:

This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay.

Results:

Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared to the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P = 0.008] and had longer hospital stay periods [23.0 (19.0-31.0) vs 16.0 (13.8-22.0), P < 0.001]. After adjusting for confounding factors, differences in primary outcomes between the two groups were not statistically significant (P = 0.167), however, patients in the IVIG group had longer hospital stay periods (P = 0.041).

Conclusion:

Adjuvant therapy with IVIG did not improve in-hospital mortality rates or the need for mechanical ventilation in severe COVID-19 patients. Our study does not support the use of immunoglobulin in patients with severe COVID-19 patients.

Keywords:

COVID-19 Hospital length of stay IVIG Mechanical ventilation Mortality SARS-CoV-2

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