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1.
Front Immunol ; 13: 841126, 2022.
Article in English | MEDLINE | ID: covidwho-1775675

ABSTRACT

The antibody profile against autoantigens previously associated with autoimmune diseases and other human proteins in patients with COVID-19 or multisystem inflammatory syndrome in children (MIS-C) remains poorly defined. Here we show that 30% of adults with COVID-19 had autoantibodies against the lung antigen KCNRG, and 34% had antibodies to the SLE-associated Smith-D3 protein. Children with COVID-19 rarely had autoantibodies; one of 59 children had GAD65 autoantibodies associated with acute onset of insulin-dependent diabetes. While autoantibodies associated with SLE/Sjögren's syndrome (Ro52, Ro60, and La) and/or autoimmune gastritis (gastric ATPase) were detected in 74% (40/54) of MIS-C patients, further analysis of these patients and of children with Kawasaki disease (KD), showed that the administration of intravenous immunoglobulin (IVIG) was largely responsible for detection of these autoantibodies in both groups of patients. Monitoring in vivo decay of the autoantibodies in MIS-C children showed that the IVIG-derived Ro52, Ro60, and La autoantibodies declined to undetectable levels by 45-60 days, but gastric ATPase autoantibodies declined more slowly requiring >100 days until undetectable. Further testing of IgG and/or IgA antibodies against a subset of potential targets identified by published autoantigen array studies of MIS-C failed to detect autoantibodies against most (16/18) of these proteins in patients with MIS-C who had not received IVIG. However, Troponin C2 and KLHL12 autoantibodies were detected in 2 of 20 and 1 of 20 patients with MIS-C, respectively. Overall, these results suggest that IVIG therapy may be a confounding factor in autoantibody measurements in MIS-C and that antibodies against antigens associated with autoimmune diseases or other human proteins are uncommon in MIS-C.


Subject(s)
Autoimmune Diseases , COVID-19 , Lupus Erythematosus, Systemic , Adaptor Proteins, Signal Transducing , Adenosine Triphosphatases , Adult , Autoantibodies , Autoantigens , Autoimmunity , COVID-19/complications , Child , Humans , Immunoglobulins, Intravenous , Ribonucleoproteins , Systemic Inflammatory Response Syndrome
3.
Lancet Respir Med ; 10(2): 158-166, 2022 02.
Article in English | MEDLINE | ID: covidwho-1751525

ABSTRACT

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a major complication of COVID-19 and is associated with high mortality and morbidity. We aimed to assess whether intravenous immunoglobulins (IVIG) could improve outcomes by reducing inflammation-mediated lung injury. METHODS: In this multicentre, double-blind, placebo-controlled trial, done at 43 centres in France, we randomly assigned patients (1:1) receiving invasive mechanical ventilation for up to 72 h with PCR confirmed COVID-19 and associated moderate-to-severe ARDS to receive either IVIG (2 g/kg over 4 days) or placebo. Random assignment was done with a web-based system and was stratified according to the participating centre and the duration of invasive mechanical ventilation before inclusion in the trial (<12 h, 12-24 h, and >24-72 h), and treatment was administered within the first 96 h of invasive mechanical ventilation. To minimise the risk of adverse events, the IVIG administration was divided into four perfusions of 0·5 g/kg each administered over at least 8 hours. Patients in the placebo group received an equivalent volume of sodium chloride 0·9% (10 mL/kg) over the same period. The primary outcome was the number of ventilation-free days by day 28, assessed according to the intention-to-treat principle. This trial was registered on ClinicalTrials.gov, NCT04350580. FINDINGS: Between April 3, and October 20, 2020, 146 patients (43 [29%] women) were eligible for inclusion and randomly assigned: 69 (47%) patients to the IVIG group and 77 (53%) to the placebo group. The intention-to-treat analysis showed no statistical difference in the median number of ventilation-free days at day 28 between the IVIG group (0·0 [IQR 0·0-8·0]) and the placebo group (0·0 [0·0-6·0]; difference estimate 0·0 [0·0-0·0]; p=0·21). Serious adverse events were more frequent in the IVIG group (78 events in 22 [32%] patients) than in the placebo group (47 events in 15 [20%] patients; p=0·089). INTERPRETATION: In patients with COVID-19 who received invasive mechanical ventilation for moderate-to-severe ARDS, IVIG did not improve clinical outcomes at day 28 and tended to be associated with an increased frequency of serious adverse events, although not significant. The effect of IVIGs on earlier disease stages of COVID-19 should be assessed in future trials. FUNDING: Programme Hospitalier de Recherche Clinique.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Double-Blind Method , Female , Humans , Immunoglobulins, Intravenous/adverse effects , Iron-Dextran Complex , Respiratory Distress Syndrome/drug therapy , SARS-CoV-2 , Treatment Outcome
5.
Neurol Neuroimmunol Neuroinflamm ; 9(3)2022 05.
Article in English | MEDLINE | ID: covidwho-1724727

ABSTRACT

BACKGROUND AND OBJECTIVES: Recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears exponential, leaving a tail of patients reporting various long COVID symptoms including unexplained fatigue/exertional intolerance and dysautonomic and sensory concerns. Indirect evidence links long COVID to incident polyneuropathy affecting the small-fiber (sensory/autonomic) axons. METHODS: We analyzed cross-sectional and longitudinal data from patients with World Health Organization (WHO)-defined long COVID without prior neuropathy history or risks who were referred for peripheral neuropathy evaluations. We captured standardized symptoms, examinations, objective neurodiagnostic test results, and outcomes, tracking participants for 1.4 years on average. RESULTS: Among 17 patients (mean age 43.3 years, 69% female, 94% Caucasian, and 19% Latino), 59% had ≥1 test interpretation confirming neuropathy. These included 63% (10/16) of skin biopsies, 17% (2/12) of electrodiagnostic tests and 50% (4/8) of autonomic function tests. One patient was diagnosed with critical illness axonal neuropathy and another with multifocal demyelinating neuropathy 3 weeks after mild COVID, and ≥10 received small-fiber neuropathy diagnoses. Longitudinal improvement averaged 52%, although none reported complete resolution. For treatment, 65% (11/17) received immunotherapies (corticosteroids and/or IV immunoglobulins). DISCUSSION: Among evaluated patients with long COVID, prolonged, often disabling, small-fiber neuropathy after mild SARS-CoV-2 was most common, beginning within 1 month of COVID-19 onset. Various evidence suggested infection-triggered immune dysregulation as a common mechanism.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/complications , Immunoglobulins, Intravenous/therapeutic use , Peripheral Nervous System Diseases/etiology , Adult , Electrodiagnosis , Female , Humans , Male , Middle Aged , Neurologic Examination , Peripheral Nervous System Diseases/drug therapy , Peripheral Nervous System Diseases/physiopathology , Treatment Outcome
6.
Brain Behav Immun ; 87: 59-73, 2020 07.
Article in English | MEDLINE | ID: covidwho-1719339

ABSTRACT

As of April 15, 2020, the ongoing coronavirus disease 2019 (COVID-2019) pandemic has swept through 213 countries and infected more than 1,870,000 individuals, posing an unprecedented threat to international health and the economy. There is currently no specific treatment available for patients with COVID-19 infection. The lessons learned from past management of respiratory viral infections have provided insights into treating COVID-19. Numerous potential therapies, including supportive intervention, immunomodulatory agents, antiviral therapy, and convalescent plasma transfusion, have been tentatively applied in clinical settings. A number of these therapies have provided substantially curative benefits in treating patients with COVID-19 infection. Furthermore, intensive research and clinical trials are underway to assess the efficacy of existing drugs and identify potential therapeutic targets to develop new drugs for treating COVID-19. Herein, we summarize the current potential therapeutic approaches for diseases related to COVID-19 infection and introduce their mechanisms of action, safety, and effectiveness.


Subject(s)
Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Adrenal Cortex Hormones/therapeutic use , Angiotensin-Converting Enzyme 2 , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Anticoagulants/therapeutic use , Antimalarials/therapeutic use , Antiviral Agents/therapeutic use , Betacoronavirus , Bevacizumab/therapeutic use , COVID-19 , COVID-19 Vaccines , Chloroquine/therapeutic use , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Humans , Hydroxychloroquine/therapeutic use , Immunization, Passive , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Interferons/therapeutic use , Janus Kinase Inhibitors/therapeutic use , Killer Cells, Natural , Medicine, Chinese Traditional , Mesenchymal Stem Cell Transplantation , Nitric Oxide/therapeutic use , Pandemics , Peptidyl-Dipeptidase A , SARS-CoV-2 , Spike Glycoprotein, Coronavirus , Trace Elements/therapeutic use , Viral Vaccines/therapeutic use , Vitamins/therapeutic use , Zinc/therapeutic use
7.
J Med Case Rep ; 16(1): 102, 2022 Mar 03.
Article in English | MEDLINE | ID: covidwho-1718002

ABSTRACT

BACKGROUND: The current coronavirus disease pandemic has brought recognition of multisystem inflammatory syndrome in adults as a de novo entity, temporally associated with severe acute respiratory syndrome coronavirus 2 viral infection in adults. Hypothesis about its true pathophysiology remains controversial. CASE REPORT: The patient was a 22-year-old African American female presenting to the emergency department with fever, sore throat, and neck swelling for the past 3 days. During her initial emergency department visit, her blood pressure was stable at 110/57 mmHg, temperature of 39.4 °C, and heart rate of 150 beats per minute. While in the emergency department, she received broad-spectrum antibiotics (vancomycin and ceftriaxone) and 30 cc/kg bolus of normal saline. Originally, she was admitted to a telemetry floor. The following night, a rapid response code was called due to hypotension. At that time, her blood pressure was 80/57 mmHg. She appeared comfortable without signs of respiratory distress. She received intravenous fluids and vasopressors, and was transferred to the intensive care unit. The patient had reported a previous coronavirus disease infection a few weeks prior. She was diagnosed and treated for multisystem inflammatory syndrome in adults. Intravenous immunoglobulin infusion was initiated and completed on hospital day 5. She was weaned off vasopressors by day 6, and discharged home on day 11. CONCLUSION: Our case report is an example of the presentation, diagnosis, and management of multisystem inflammatory syndrome. Our research into previous case reports illustrates the wide range of presentations, degree of end organ damage, and treatment modalities. This diagnosis needs to be considered in the presence of recent coronavirus disease infection with new-onset end organ failure, as prompt diagnosis and treatment is crucial for better outcomes.


Subject(s)
COVID-19 , Adult , COVID-19/complications , Female , Fever/etiology , Humans , Immunoglobulins, Intravenous , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Young Adult
8.
Front Immunol ; 13: 790334, 2022.
Article in English | MEDLINE | ID: covidwho-1715001

ABSTRACT

The capacity of pre-existing immunity to human common coronaviruses (HCoV) to cross-protect against de novo COVID-19is yet unknown. In this work, we studied the sera of 175 COVID-19 patients, 76 healthy donors and 3 intravenous immunoglobulins (IVIG) batches. We found that most COVID-19 patients developed anti-SARS-CoV-2 IgG antibodies before IgM. Moreover, the capacity of their IgGs to react to beta-HCoV, was present in the early sera of most patients before the appearance of anti-SARS-CoV-2 IgG. This implied that a recall-type antibody response was generated. In comparison, the patients that mounted an anti-SARS-COV2 IgM response, prior to IgG responses had lower titres of anti-beta-HCoV IgG antibodies. This indicated that pre-existing immunity to beta-HCoV was conducive to the generation of memory type responses to SARS-COV-2. Finally, we also found that pre-COVID-19-era sera and IVIG cross-reacted with SARS-CoV-2 antigens without neutralising SARS-CoV-2 infectivity in vitro. Put together, these results indicate that whilst pre-existing immunity to HCoV is responsible for recall-type IgG responses to SARS-CoV-2, it does not lead to cross-protection against COVID-19.


Subject(s)
Betacoronavirus/physiology , COVID-19/immunology , Common Cold/immunology , Immunoglobulins, Intravenous/therapeutic use , SARS-CoV-2/physiology , Aged , Aged, 80 and over , Antibodies, Neutralizing/metabolism , Antibodies, Viral/metabolism , Antigens, Viral/immunology , COVID-19/mortality , COVID-19/therapy , Cross Reactions , Female , Humans , Immunity, Heterologous , Immunoglobulin G/metabolism , Immunoglobulin M/metabolism , Immunologic Memory , Male , Middle Aged , Survival Analysis
10.
Medicine (Baltimore) ; 101(6): e28758, 2022 Feb 11.
Article in English | MEDLINE | ID: covidwho-1708012

ABSTRACT

RATIONALE: Sleep disturbance is commonly noted after Guillain-Barré syndrome (GBS) and is often caused by persistent discomfort after disease survival. Intravascular laser irradiation of blood (ILIB) has been shown to be effective in pain modulation owing to the influence of nociceptive signals in the peripheral nervous system. We investigated the application of ILIB on post-Oxford -AstraZeneca vaccination GBS and evaluated its effect on sleep quality. PATIENT CONCERNS: A 48-year-old woman was subsequently diagnosed with GBS after Oxford-AstraZeneca vaccination. The patient was discharged after a 5-day course of intravenous immunoglobulin administration. However, 1 week after discharge, the previously relieved symptoms flared with accompanying sleep disturbance. DIAGNOSIS AND INTERVENTIONS: The patient was diagnosed with post-vaccination GBS, and persistent pain and sleep disturbances persisted after disease survival. ILIB was performed. OUTCOMES: We used the Pittsburgh Sleep Quality Index before and after intravascular laser irradiation. There was a marked improvement in the sleep duration, efficiency, and overall sleep quality. The initial score was 12 out of 21 and the final score was 7 out of 21. LESSONS: We found that ILIB was effective in pain modulation in post-vaccination GBS and significantly improved sleep quality.


Subject(s)
/adverse effects , Guillain-Barre Syndrome/chemically induced , Low-Level Light Therapy , Sleep Wake Disorders/therapy , COVID-19 Vaccines , Female , Guillain-Barre Syndrome/complications , Guillain-Barre Syndrome/drug therapy , Humans , Immunoglobulins, Intravenous/administration & dosage , Immunoglobulins, Intravenous/therapeutic use , Middle Aged , Pain , Sleep , Sleep Wake Disorders/etiology , Vaccination/adverse effects
11.
Cardiol Young ; 31(6): 1021-1023, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1701004

ABSTRACT

A 12-year-old girl presented with fever and signs of systemic inflammation, and was found to have junctional tachycardia. She was subsequently diagnosed with Multisystem Inflammatory Syndrome in Children and treated with intravenous immunoglobulin and steroids, which led to resolution of the arrhythmia.


Subject(s)
COVID-19 , Child , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , SARS-CoV-2 , Systemic Inflammatory Response Syndrome , Tachycardia/diagnosis , Tachycardia/etiology
12.
Eur J Med Res ; 27(1): 18, 2022 Feb 03.
Article in English | MEDLINE | ID: covidwho-1701526

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, different treatments have been used in critically ill patients. Using intravenous immunoglobulin (IVIG) has been suggested in various studies as an effective option. Our study aims to access the efficacy of IVIG in critically ill COVID-19 patients. METHODS: In this retrospective matched cohort study, records of three tertiary centers with a large number of COVID-19 admissions were evaluated and used. Based on treatment options, patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using an independent t test and one-way analysis of variance (ANOVA) to compare the outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate. RESULTS: The duration of hospitalization in the IVIG group was significantly longer than standard treatment (13.74 days vs. 11.10 days, p < 0.05). There was no significant difference between the two groups in ICU length of stay, the number of intubated patients, and duration of mechanical ventilation (p > 0.05). Also, initial outcomes in IVIG subgroups were compared separately with the standard treatment group. The results indicated that only the duration of hospitalization in the IVIG subgroup with medium dose is significantly longer than the standard treatment group (p < 0.01). CONCLUSION: Our data indicate that the use of IVIG in critically ill COVID-19 patients could not be beneficial, based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation, and even mortality rate.


Subject(s)
COVID-19/drug therapy , Critical Illness , Immunoglobulins, Intravenous/therapeutic use , SARS-CoV-2/drug effects , Aged , COVID-19/epidemiology , COVID-19/virology , Female , Humans , Immunologic Factors/therapeutic use , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/statistics & numerical data , Pandemics/prevention & control , Respiration, Artificial , Retrospective Studies , SARS-CoV-2/physiology
13.
J Korean Med Sci ; 37(7): e58, 2022 Feb 21.
Article in English | MEDLINE | ID: covidwho-1704893

ABSTRACT

Guillain-Barre syndrome (GBS) is an immune-mediated acute polyradiculoneuropathy and commonly occurs after a preceding infection or immunization sequalae. Following the severe acute respiratory syndrome-coronavirus-2 virus pandemic with co-introduction of massive vaccinations, several GBS cases associated with coronavirus disease 2019 (COVID-19) infection per se or after vaccination for COVID-19 were reported internationally. Herein, we report two cases of Korean GBS presenting with tetraplegia after two different COVID-19 vaccinations (42-year old man by AstraZeneca and 48-year woman by Pfizer vaccines) within four weeks after vaccination. The patients were diagnosed with clinical examination, serial electromyography, and compatible laboratory results and improved after comprehensive rehabilitative treatment and intravenous immunoglobulin therapy. Furthermore, we performed an electrodiagnostic follow-up study of each case to examine their unique characteristics.


Subject(s)
/adverse effects , Guillain-Barre Syndrome/pathology , Quadriplegia/pathology , Vaccination/adverse effects , Adult , COVID-19/prevention & control , Electromyography , Female , Guillain-Barre Syndrome/rehabilitation , Guillain-Barre Syndrome/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Middle Aged , Quadriplegia/rehabilitation , Quadriplegia/therapy , SARS-CoV-2/immunology
14.
Infect Dis Clin North Am ; 36(1): 1-14, 2022 03.
Article in English | MEDLINE | ID: covidwho-1693434

ABSTRACT

Although COVID-19 has impacted many children, severe disease is rare and most recover with supportive care. Manifestations are diverse and often nonrespiratory. Adolescents/children with medical comorbidities are at risk for severe respiratory compromise. The most serious manifestation in previously healthy children is a delayed multisystem inflammatory syndrome with cardiac compromise in severe cases. Anti-SARS-CoV-2 monoclonal antibodies are available for adolescents at risk of progression and not hospitalized. Therapeutic options for severe respiratory disease with hypoxia include remdesivir and glucocorticoids. Therapies for multisystem inflammatory syndrome in children include intravenous immunoglobulin and glucocorticoids. Refractory cases may benefit from additional immunomodulators.


Subject(s)
COVID-19 , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adolescent , Alanine/analogs & derivatives , Alanine/therapeutic use , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Child , Glucocorticoids/therapeutic use , Hospitalization , Humans , Immunoglobulins, Intravenous/therapeutic use , Systemic Inflammatory Response Syndrome
16.
Front Immunol ; 12: 738532, 2021.
Article in English | MEDLINE | ID: covidwho-1686470

ABSTRACT

Background: The benefits of intravenous immunoglobulin administration are controversial for critically ill COVID-19 patients. Methods: We analyzed retrospectively the effects of immunoglobulin administration for critically ill COVID-19 patients. The primary outcome was 28-day mortality. Inverse probability of treatment weighting (IPTW) with propensity score was used to account for baseline confounders. Cluster analysis was used to perform phenotype analysis. Results: Between January 1 and February 29, 2020, 754 patients with complete data from 19 hospitals were enrolled. Death at 28 days occurred for 408 (54.1%) patients. There were 392 (52.0%) patients who received intravenous immunoglobulin, at 11 (interquartile range (IQR) 8, 16) days after illness onset; 30% of these patients received intravenous immunoglobulin prior to intensive care unit (ICU) admission. By unadjusted analysis, no difference was observed for 28-day mortality between the immunoglobulin and non-immunoglobulin groups. Similar results were found by propensity score matching (n = 506) and by IPTW analysis (n = 731). Also, IPTW analysis did not reveal any significant difference between hyperinflammation and hypoinflammation phenotypes. Conclusion: No significant association was observed for use of intravenous immunoglobulin and decreased mortality of severe COVID-19 patients. Phenotype analysis did not show any survival benefit for patients who received immunoglobulin therapy.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Immunoglobulins, Intravenous/therapeutic use , Aged , China , Critical Care/methods , Critical Illness/therapy , Female , Humans , Immunization, Passive/methods , Immunization, Passive/mortality , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/immunology , Treatment Outcome
17.
Pediatr Infect Dis J ; 41(3): e93-e94, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1684870

ABSTRACT

Multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection is well known. We describe a 12-year-old child developing MIS-C after receiving 2 doses of mRNA COVID-19 vaccines without clinical evidence of COVID-19 infection. A possible association between the SARS-CoV-2 vaccine and MIS-C cannot be excluded.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/complications , Systemic Inflammatory Response Syndrome/etiology , /adverse effects , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/etiology , COVID-19/prevention & control , Child , Diagnosis, Differential , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapy
18.
Reumatismo ; 73(4)2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1674965

ABSTRACT

Neutrophilic myositis (NM) is an inflammatory disorder predominantly characterized by neutrophilic infiltration in the muscles, which is suggested to be an extracutaneous manifestation of neutrophilic dermatosis (ND). NM is a rare disorder which has been occasionally reported in association with hematologic and inflammatory disorders. This case report describes a 45-year-old woman who presented with gradual muscle weakness developed after coronavirus disease 2019 (COVID-19) infection. Electromyography and nerve conduction velocity findings were compatible with inflammatory myopathy and muscle biopsy revealed neutrophilic infiltration. She was successfully treated with intravenous immunoglobulin, prednisolone 1 mg/kg/day and azathioprine 150 mg/day. In conclusion, the COVID-19 infection itself and the drugs used to treat it can cause a number of muscle disorders. Awareness of muscular involvement in COVID-19 infected patients is important for early diagnosis and appropriate treatment.


Subject(s)
COVID-19 , Myositis , Adrenal Cortex Hormones , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Middle Aged , Myositis/drug therapy , SARS-CoV-2
19.
Int Immunopharmacol ; 106: 108615, 2022 May.
Article in English | MEDLINE | ID: covidwho-1670617

ABSTRACT

BACKGROUND: Various immunomodulatory therapies have been explored to manage the dysregulated immune response seen in severe COVID-19 infection. The objective of this study was to evaluate the efficacy of intravenous immunoglobulin (IVIG) in severe and critical COVID-19 disease. METHODS: This retrospective study included 535 patients with severe and critical COVID-19 admitted to the intensive care unit (ICU) of a tertiary care hospital, from May 2020 to December 2020. Primary outcome was the percentage of patients requiring mechanical ventilation. Secondary outcomes were a) in-hospital mortality, b) 28-day mortality, c) ICU-length of stay (ICU-LOS), d) days to discontinuation of supplemental oxygen, and e) days to COVID-PCR negativity. Logistic regression and linear regression were performed using the adjusted and unadjusted analyses. RESULTS: We analyzed a total of 535 patients out of which 255 (47.7%) received IVIG along with standard treatment and 280 (52.3%) received only standard treatment. Two groups were similar in terms of COVID-19 severity, APACHE II score, oxygen requirements, and initial management. The requirement of invasive ventilation was significantly less in the IVIG group compared to the Non-IVIG group (32.2% vs 40.4%, p < 0.05). In-hospital mortality, 28-day mortality, and ICU-LOS were also significantly less in the IVIG group (all p < 0.05). Subgroup analysis within the IVIG group showed that early administration of IVIG (≤7 days from ICU admission), old age (≥65 years), and obesity were associated with better outcomes (need for mechanical ventilation and in-hospital mortality) (all p < 0.05). IVIG administration in patients with chronic respiratory disease was associated with a reduced requirement for mechanical ventilation (p < 0.05), but there was an insignificant improvement in mortality. CONCLUSION: High-dose IVIG improves outcomes in severe and critical COVID-19 patients. The study also underscores the importance of timing and patient selection when administering IVIG.


Subject(s)
COVID-19 , Immunoglobulins, Intravenous , Aged , COVID-19/drug therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Intensive Care Units , Respiration, Artificial , Retrospective Studies , SARS-CoV-2
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