Intravenous immunoglobulin treatment for patients with severe COVID-19: a retrospective multi-center study

Liu, Jiao; Chen, Yizhu; Li, Ranran; Wu, Zhixiong; Xu, Qianghong; Li, Zhongyi; Annane, Djillali; Feng, Huibin; Huang, Sisi; Guo, Jun; Zhang, Lidi; Ye, Xiaofei; Zhu, Wei; Du, Hangxiang; Liu, Yong’an; Wang, Tao; Chen, Limin; Wen, Zhenliang; Teboul, Jean-Louis; Chen, Dechang

OBJECTIVES: Intravenous immunoglobulin (IVIG) is commonly used to treat severe COVID-19, although the clinical outcome of such treatment remains unclear. This study evaluated the effectiveness of IVIG treatment in severe COVID-19 patients. METHODS: This retrospective multicenter study evaluated 28-day mortality in severe COVID-19 patients with or without IVIG treatment. Each patient treated with IVIG was matched with one untreated patient. Logistic regression and inverse probability weighting(IPW)was used to control confounding factors. RESULTS: The study included 850 patients (421 IVIG treated patients and 429 non-IVIG treated patients). After matching, 406 patients per group remained. No significant difference in 28-day mortality was observed after IPW analysis (ATE = 0.008, 95% CI -0.081–0.097, p = 0.863). There were no significant differences between the IVIG group and non-IVIG group for acute respiratory distress syndrome, diffuse intravascular coagulation, myocardial injury, acute hepatic injury, shock, acute kidney injury, non-invasive mechanical ventilation, invasive mechanical ventilation, continuous renal replacement therapy, and extracorporeal membrane oxygenation except for prone position ventilation (ATE = -0.022, 95% CI -0.041– -0.002, p = 0.028). CONCLUSIONS: IVIG treatment was not associated with significant changes in 28-day mortality in severe COVID-19 patients. The effectiveness of IVIG in treating patients with severe COVID-19 needs to be further investigated through future studies.