Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study

BMC Pulmonary Medicine

Mohamed A. Abdelaty¹  Husain S. Ali¹  Saibu George¹  Mohamed O. Saad²  Hassan A. Mitwally²  Nissar Shaikh³  Moustafa S. Elshafei⁴  Dore C. Ananthegowda⁴  Mohammad Al Wraidat⁴  Ahmed S. Mohamed⁴  Mohamad Y. Khatib⁴  Asra Aroos⁴  Abdulqadir J. Nashwan⁴ 

[1] Department of Medical ICU/Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar;Department of Pharmacy, Al Wakra Hospital, Al Wakrah, Qatar;Department of Surgical ICU, Hamad General Hospital, Doha, Qatar;Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar;

关键词: Acute respiratory distress syndrome;    COVID-19;    ICU mortality;    Intravenous immunoglobulin;    Mechanical ventilation;   

DOI  :  10.1186/s12890-021-01717-x

来源: Springer

【 摘 要 】

BackgroundIntravenous immunoglobulin (IVIG) has been used as an immunomodulatory therapy to counteract severe systemic inflammation in coronavirus disease 2019 (COVID-19). But its use in COVID-19 related acute respiratory distress syndrome (ARDS) is not well established.MethodsWe conducted a retrospective analysis of electronic health records of COVID-19 patients admitted to intensive care units (ICUs) at Hazm Mebaireek General Hospital, Qatar, between March 7, 2020 and September 9, 2020. Patients receiving invasive mechanical ventilation for moderate-to-severe ARDS were divided into two groups based on whether they received IVIG therapy or not. The primary outcome was all-cause ICU mortality. Secondary outcomes studied were ventilator-free days and ICU-free days at day-28, and incidence of acute kidney injury (AKI). Propensity score matching was used to adjust for confounders, and the primary outcome was compared using competing-risks survival analysis.ResultsAmong 590 patients included in the study, 400 received routine care, and 190 received IVIG therapy in addition to routine care. One hundred eighteen pairs were created after propensity score matching with no statistically significant differences between the groups. Overall ICU mortality in the study population was 27.1%, and in the matched cohort, it was 25.8%. Mortality was higher among IVIG-treated patients (36.4% vs. 15.3%; sHR 3.5; 95% CI 1.98–6.19; P < 0.001). Ventilator-free days and ICU-free days at day-28 were lower (P < 0.001 for both), and incidence of AKI was significantly higher (85.6% vs. 67.8%; P = 0.001) in the IVIG group.ConclusionIVIG therapy in mechanically ventilated patients with COVID-19 related moderate-to-severe ARDS was associated with higher ICU mortality. A randomized clinical trial is needed to confirm this observation further.

【 授权许可】

CC BY