About: Clinical Efficacy of Intravenous Immunoglobulin Therapy in Critical Patients with COVID-19: A multicenter retrospective cohort study

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Clinical Efficacy of Intravenous Immunoglobulin Therapy in Critical Patients with COVID-19: A multicenter retrospective cohort study
Creator	Lei, Ming Feng, Yongwen Zhong, Li Hu, Wu, Ming Su, Lei Wang, Conglin Liu, Zhifeng Su, Gu, Zhengtao Hu, Zhongwei Ji, Jingjing Li, Weichao Liu, Zheying Shao, Ziyun Xie, Qifeng
source	MedRxiv
abstract	Summary Background Coronavirus disease 2019 (COVID-19) has spread all over the world, causing more than 1.5 million infections and over ten thousands of deaths in a short period of time. However, little is known about its pathological mechanism, and there are still no clinical study reports on specific treatment. The purpose of this study is to determine the clinical efficacy of intravenous immunoglobulin (IVIG) therapy on COVID-19. Methods In this multicenter retrospective cohort study, adult critical COVID-19 patients (including severe type and critical type, according to the clinical classification defined by National Health Commission of China) in 8 government designated treatment center in China from Dec 23, 2019 to Mar 31, 2020 were enrolled. Demographic, clinical, treatment, and laboratory data, prognosis were extracted from electronic medical records, and IVIG was exposure factor. Primary outcomes were the 28 days and 60 days mortality, and secondary outcomes were the total length of in-hospital and the total duration of the disease. Meanwhile, the parameters of inflammation response and organ function were detected. The risk factors were determined by COX proportional hazards model. The subgroup analysis was carried out according to clinical classification of COVID-19, IVIG dosage and timing. Findings 325patients were included in this study, of whom 222 (68%) were severe type, 103 (32%) were critical type. 42 (13%) died in 28 days within hospitalization, total 54 (17%) died in 60 days, and 6 (3%) died in severe type, 48 (47%) died in critical type. 174 cases were used IVIG, and 151 cases were not. Compared with the baseline characteristics between two groups, the results showed that the patients in IVIG group had higher Acute Physiology and Chronic Health Evaluation (APACHII) score, Sequential Organ Failure Assessment (SOFA) score, IL-6 and lactate level, lower lymphocyte count and oxygenation index (all P<0.05). The 28 day and 60 day mortality did not improve with IVIG in overall patients. The in-hospital stay and the total duration of disease were longer in IVIG group (p<0.001). Risk factors were clinical classification (hazards ratio 0.126, 95% confidence interval 0.039-0.413, P=0.001), and using IVIG (hazards ratio 0.252, 95% confidence interval 0.107-0.591, P=0.002) with COX regression. Subgroup analysis showed that only in patients with critical type, IVIG could significantly reduce the 28 day mortality, decrease the inflammatory response and improve some organ functions (all p<0.05), and 60-day mortality reduced significantly by using IVIG in the early stage (admission[≤]7 days) and with high dose (>15 g/d). Interpretation Early and high dose of IVIG therapy may improve the prognosis of COVID-19 patients only in critical type, which provides the clinical basis for the choice of treatment population and method of IVIG therapy for the SARS-CoV-2 infection. Keywords: SARS-COV-2, COVID-19, IVIG, clinical efficacy, mortality
has issue date	2020-04-15(xsd:dateTime)
bibo:doi	10.1101/2020.04.11.20061739
has license	medrxiv
sha1sum (hex)	02db99462cf8427a689af1811194e644b7e234ab
schema:url	https://doi.org/10.1101/2020.04.11.20061739
resource representing a document's title	Clinical Efficacy of Intravenous Immunoglobulin Therapy in Critical Patients with COVID-19: A multicenter retrospective cohort study
resource representing a document's body	covid:02db99462cf8427a689af1811194e644b7e234ab#body_text
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