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Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study.
Ali, Husain S; Elshafei, Moustafa S; Saad, Mohamed O; Mitwally, Hassan A; Al Wraidat, Mohammad; Aroos, Asra; Shaikh, Nissar; Ananthegowda, Dore C; Abdelaty, Mohamed A; George, Saibu; Nashwan, Abdulqadir J; Mohamed, Ahmed S; Khatib, Mohamad Y.
  • Ali HS; Department of Medical ICU/Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar. hali10@hamad.qa.
  • Elshafei MS; Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar.
  • Saad MO; Department of Pharmacy, Al Wakra Hospital, Al Wakrah, Qatar.
  • Mitwally HA; Department of Pharmacy, Al Wakra Hospital, Al Wakrah, Qatar.
  • Al Wraidat M; Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar.
  • Aroos A; Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar.
  • Shaikh N; Department of Surgical ICU, Hamad General Hospital, Doha, Qatar.
  • Ananthegowda DC; Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar.
  • Abdelaty MA; Department of Medical ICU/Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar.
  • George S; Department of Medical ICU/Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar.
  • Nashwan AJ; Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar.
  • Mohamed AS; Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar.
  • Khatib MY; Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar.
BMC Pulm Med ; 21(1): 354, 2021 Nov 08.
Article in English | MEDLINE | ID: covidwho-1505545
ABSTRACT

BACKGROUND:

Intravenous 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.

METHODS:

We 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.

RESULTS:

Among 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.

CONCLUSION:

IVIG 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.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Respiratory Distress Syndrome / Immunoglobulins, Intravenous / COVID-19 / Immunologic Factors Subject: Respiratory Distress Syndrome / Immunoglobulins, Intravenous / COVID-19 / Immunologic Factors Type of study: Controlled clinical trial / Etiology study / Observational study / Risk factors Language: English Journal: BMC Pulm Med Clinical aspect: Etiology / Therapy Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Respiratory Distress Syndrome / Immunoglobulins, Intravenous / COVID-19 / Immunologic Factors Subject: Respiratory Distress Syndrome / Immunoglobulins, Intravenous / COVID-19 / Immunologic Factors Type of study: Controlled clinical trial / Etiology study / Observational study / Risk factors Language: English Journal: BMC Pulm Med Clinical aspect: Etiology / Therapy Year: 2021
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