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Immunoglobulin deficiency as an indicator of disease severity in patients with COVID-19.
Husain-Syed, Faeq; Vadász, István; Wilhelm, Jochen; Walmrath, Hans-Dieter; Seeger, Werner; Birk, Horst-Walter; Jennert, Birgit; Dietrich, Hartmut; Herold, Susanne; Trauth, Janina; Tello, Khodr; Sander, Michael; Morty, Rory E; Slanina, Heiko; Schüttler, Christian G; Ziebuhr, John; Kassoumeh, Shadi; Ronco, Claudio; Ferrari, Fiorenza; Warnatz, Klaus; Stahl, Klaus; Seeliger, Benjamin; Hoeper, Marius M; Welte, Tobias; David, Sascha.
  • Husain-Syed F; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Vadász I; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Wilhelm J; International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.
  • Walmrath HD; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Seeger W; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, German Center for Lung Research, Giessen, Germany.
  • Birk HW; The Cardio-Pulmonary Institute, Giessen, Germany.
  • Jennert B; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, German Center for Lung Research, Giessen, Germany.
  • Dietrich H; The Cardio-Pulmonary Institute, Giessen, Germany.
  • Herold S; Institute for Lung Health, Justus Liebig University Giessen, Giessen, Germany.
  • Trauth J; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Tello K; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Sander M; Division of Infectious Diseases, Department of Internal Medicine II, Department of Internal Medicine, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Morty RE; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Slanina H; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Schüttler CG; Division of Infectious Diseases, Department of Internal Medicine II, Department of Internal Medicine, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Ziebuhr J; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, German Center for Lung Research, Giessen, Germany.
  • Kassoumeh S; The Cardio-Pulmonary Institute, Giessen, Germany.
  • Ronco C; Institute for Lung Health, Justus Liebig University Giessen, Giessen, Germany.
  • Ferrari F; Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany.
  • Warnatz K; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Stahl K; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Seeliger B; Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Hoeper MM; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • Welte T; Division of Infectious Diseases, Department of Internal Medicine II, Department of Internal Medicine, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.
  • David S; Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, German Center for Lung Research, Giessen, Germany.
Am J Physiol Lung Cell Mol Physiol ; 320(4): L590-L599, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-945036
ABSTRACT
Despite the pandemic status of COVID-19, there is limited information about host risk factors and treatment beyond supportive care. Immunoglobulin G (IgG) could be a potential treatment target. Our aim was to determine the incidence of IgG deficiency and associated risk factors in a cohort of 62 critically ill patients with COVID-19 admitted to two German ICUs (72.6% male, median age 61 yr). Thirteen (21.0%) of the patients displayed IgG deficiency (IgG < 7 g/L) at baseline (predominant for the IgG1, IgG2, and IgG4 subclasses). Patients who were IgG-deficient had worse measures of clinical disease severity than those with normal IgG levels (shorter duration from disease onset to ICU admission, lower ratio of [Formula see text] to [Formula see text], higher Sequential Organ Failure Assessment score, and higher levels of ferritin, neutrophil-to-lymphocyte ratio, and serum creatinine). Patients who were IgG-deficient were also more likely to have sustained lower levels of lymphocyte counts and higher levels of ferritin throughout the hospital stay. Furthermore, patients who were IgG-deficient compared with those with normal IgG levels displayed higher rates of acute kidney injury (76.9% vs. 26.5%; P = 0.001) and death (46.2% vs. 14.3%; P = 0.012), longer ICU [28 (6-48) vs. 12 (3-18) days; P = 0.012] and hospital length of stay [30 (22-50) vs. 18 (9-24) days; P = 0.004]. Univariable logistic regression showed increasing odds of 90-day overall mortality associated with IgG-deficiency (odds ratio 5.14, 95% confidence interval 1.3-19.9; P = 0.018). IgG deficiency might be common in patients with COVID-19 who are critically ill, and warrants investigation as both a marker of disease severity as well as a potential therapeutic target.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Severity of Illness Index / Immunoglobulins / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Language: English Journal: Am J Physiol Lung Cell Mol Physiol Journal subject: Molecular Biology / Physiology Year: 2021 Document Type: Article Affiliation country: Ajplung.00359.2020

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Severity of Illness Index / Immunoglobulins / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Language: English Journal: Am J Physiol Lung Cell Mol Physiol Journal subject: Molecular Biology / Physiology Year: 2021 Document Type: Article Affiliation country: Ajplung.00359.2020