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

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 conduct...

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Autores principales:	Husain S. Ali, Moustafa S. Elshafei, Mohamed O. Saad, Hassan A. Mitwally, Mohammad Al Wraidat, Asra Aroos, Nissar Shaikh, Dore C. Ananthegowda, Mohamed A. Abdelaty, Saibu George, Abdulqadir J. Nashwan, Ahmed S. Mohamed, Mohamad Y. Khatib
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Acute respiratory distress syndrome COVID-19 ICU mortality Intravenous immunoglobulin Mechanical ventilation Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/386dc40f31d34a41ab3d998b93a9a9e6
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spelling	oai:doaj.org-article:386dc40f31d34a41ab3d998b93a9a9e62021-11-14T12:37:27ZClinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study10.1186/s12890-021-01717-x1471-2466https://doaj.org/article/386dc40f31d34a41ab3d998b93a9a9e62021-11-01T00:00:00Zhttps://doi.org/10.1186/s12890-021-01717-xhttps://doaj.org/toc/1471-2466Abstract 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.Husain S. AliMoustafa S. ElshafeiMohamed O. SaadHassan A. MitwallyMohammad Al WraidatAsra AroosNissar ShaikhDore C. AnanthegowdaMohamed A. AbdelatySaibu GeorgeAbdulqadir J. NashwanAhmed S. MohamedMohamad Y. KhatibBMCarticleAcute respiratory distress syndromeCOVID-19ICU mortalityIntravenous immunoglobulinMechanical ventilationDiseases of the respiratory systemRC705-779ENBMC Pulmonary Medicine, Vol 21, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Acute respiratory distress syndrome COVID-19 ICU mortality Intravenous immunoglobulin Mechanical ventilation Diseases of the respiratory system RC705-779
spellingShingle	Acute respiratory distress syndrome COVID-19 ICU mortality Intravenous immunoglobulin Mechanical ventilation Diseases of the respiratory system RC705-779 Husain S. Ali Moustafa S. Elshafei Mohamed O. Saad Hassan A. Mitwally Mohammad Al Wraidat Asra Aroos Nissar Shaikh Dore C. Ananthegowda Mohamed A. Abdelaty Saibu George Abdulqadir J. Nashwan Ahmed S. Mohamed Mohamad Y. Khatib Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study
description	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.
format	article
author	Husain S. Ali Moustafa S. Elshafei Mohamed O. Saad Hassan A. Mitwally Mohammad Al Wraidat Asra Aroos Nissar Shaikh Dore C. Ananthegowda Mohamed A. Abdelaty Saibu George Abdulqadir J. Nashwan Ahmed S. Mohamed Mohamad Y. Khatib
author_facet	Husain S. Ali Moustafa S. Elshafei Mohamed O. Saad Hassan A. Mitwally Mohammad Al Wraidat Asra Aroos Nissar Shaikh Dore C. Ananthegowda Mohamed A. Abdelaty Saibu George Abdulqadir J. Nashwan Ahmed S. Mohamed Mohamad Y. Khatib
author_sort	Husain S. Ali
title	Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study
title_short	Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study
title_full	Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study
title_fullStr	Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study
title_full_unstemmed	Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study
title_sort	clinical outcomes of intravenous immunoglobulin therapy in covid-19 related acute respiratory distress syndrome: a retrospective cohort study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/386dc40f31d34a41ab3d998b93a9a9e6
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Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study

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