Intravenous immunoglobulin treatment for patients with severe COVID-19: a retrospective multi-center study

Authors: Liu, J; Chen, Y; Li, R; Wu, Z; Xu, Q; Li, Z; Annane, D; Feng, H; Huang, S; Guo, J.

Affiliations: Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai 200025, China ; Department of Surgical Intensive Care Unit, Huadong Hospital Affiliated to Fudan University, No. 221 West Yan’an Road, Shanghai 200040, China ; Department of Critical Care Medicine, Zhejiang Hospital, No.12 Lingyin Road, Hangzhou 310015, China; Department of Critical Care Medicine, Wuhan No.9 Hospital, No. 20 Jiling Street, Wuhan 430080, China Intensive Care Unit, Tianyou Hospital Affiliated to Wuhan University of Science ; Technology, No.9 Tujialing Road, Wuhan 430064, China ; Service de Médecine-Intensive Réanimation, Hôpital Bicêtre, 1 AP-HP. Université Paris-Saclay, Inserm UMR 999, Université Paris-Saclay, Le Kremlin-Bicêtre 94270, France (…)

Publication: Clinical microbiology and infection; June 2021

Abstract: OBJECTIVES: Intravenous immunoglobulin (IVIG) is commonly used to treat severe COVID-19, although the clinical outcome of such treatment remains unclear. This study evaluated the effectiveness of IVIG treatment in severe COVID-19 patients. METHODS: This retrospective multicenter study evaluated 28-day mortality in severe COVID-19 patients with or without IVIG treatment. Each patient treated with IVIG was matched with one untreated patient. Logistic regression and inverse probability weighting （IPW）was used to control confounding factors. RESULTS: The study included 850 patients (421 IVIG treated patients and 429 non-IVIG treated patients). After matching, 406 patients per group remained. No significant difference in 28-day mortality was observed after IPW analysis (ATE = 0.008, 95% CI -0.081–0.097, p = 0.863). There were no significant differences between the IVIG group and non-IVIG group for acute respiratory distress syndrome, diffuse intravascular coagulation, myocardial injury, acute hepatic injury, shock, acute kidney injury, non-invasive mechanical ventilation, invasive mechanical ventilation, continuous renal replacement therapy, and extracorporeal 1 membrane oxygenation except for prone position ventilation (ATE = -0.022, 95% CI -0.041– -0.002, p = 0.028). CONCLUSIONS: IVIG treatment was not associated with significant changes in 28-day mortality in severe COVID-19 patients. The effectiveness of IVIG in treating patients with severe COVID-19 needs to be further investigated through future studies.