Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Curr Med Res Opin. 2021 Apr;37(4):543-548. doi: 10.1080/03007995.2020.1856058. Epub 2021 Feb 14.
To evaluate the effect of adjunct treatment with Octagam, an intravenous immunoglobulin (IVIG) product, on clinical outcomes and biomarkers in critically ill COVID-19 patients.
Data from a single center was analyzed retrospectively. Patients had received preliminary standard intensive care (SIC) according to a local treatment algorithm, either alone or along with IVIG 5% at 30 g/day for 5 days. The two groups were compared regarding baseline characteristics, survival and changes in inflammation markers. Imbalance in baseline APACHE II scores was addressed by propensity score matching. Otherwise, Kaplan-Meier and multiple logistic regression models were used.
Out of 93 patients, 51 had received IVIG and 42 had not. About 75% of patients were male and both groups had comparable body mass index and AB0 blood type distribution. IVIG-treated patients were younger (mean 65 ± 15 versus 71 ± 15 years, = .066) and had slightly lower baseline disease scores (APACHE II: 20.6 versus 22.4, = .281; SOFA: 5.0 versus 7.0, = .006). Overall survival was 61% in the SIC + IVIG and 38% in the SIC only group (odds ratio: 2.2, 95% confidence interval: 0.9-5.4, = .091 after controlling for baseline imbalances). IVIG significantly prolonged median survival time (68 versus 18 days, = .014) and significantly reduced plasma levels of C-reactive protein (median change from baseline -71.5 versus -0.3 mg/L, = .049).
Clinically relevant benefits through adjunct IVIG treatment in COVID-19 need to be confirmed in a randomized, controlled trial.
评估静脉注射免疫球蛋白（IVIG）产品 Octagam 辅助治疗对危重症 COVID-19 患者临床结局和生物标志物的影响。
回顾性分析单中心数据。患者根据当地治疗方案接受了初步标准强化治疗（SIC），单独或联合 IVIG 5% 30g/天治疗 5 天。比较两组患者的基线特征、生存情况和炎症标志物变化。采用倾向评分匹配校正基线 APACHE II 评分的不平衡。否则，采用 Kaplan-Meier 和多因素逻辑回归模型。
93 例患者中，51 例接受了 IVIG 治疗，42 例未接受。约 75%的患者为男性，两组患者的体重指数和 AB0 血型分布相似。IVIG 治疗组患者更年轻（平均 65±15 岁比 71±15 岁， = .066），基线疾病评分略低（APACHE II：20.6 比 22.4， = .281；SOFA：5.0 比 7.0， = .006）。SIC+IVIG 组总体生存率为 61%，SIC 组为 38%（比值比：2.2，95%置信区间：0.9-5.4，校正基线不平衡后 = .091）。IVIG 治疗显著延长了中位生存时间（68 比 18 天， = .014），显著降低了 C 反应蛋白的血浆水平（中位变化自基线下降-71.5 比-0.3mg/L， = .049）。
COVID-19 患者接受 IVIG 辅助治疗的临床获益尚需在随机对照试验中进一步证实。
