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

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.