Use of intravenous immunoglobulin for the treatment of severe COVID‐19 in the Chris Hani Baragwanath Academic Hospital intensive care unit, Johannesburg, South Africa

Main Article Content

G Mensky
A van Blydenstein
J Damelin
S Omar

Abstract





Background. COVID‐19 infection has a variable clinical presentation, with a small subgroup of patients developing severe disease, requiring intensive care with mechanical ventilation, with an increased mortality rate. South Africa (SA) has experienced multiple waves of this pandemic, spanning the pre‐vaccine and vaccine periods. The method and initiation of treatment is a debated topic, changing according to evolving research and the literature. The present study investigated the use of high‐dose intravenous immunoglobulin (IVIg) as a salvage therapy after initial medical treatment failure.


Objectives. To compare disease progression among critically ill COVID‐19 pneumonia patients receiving IVIg therapy with that in patients receiving standard of care (SoC), in respect of inflammation, organ dysfunction and oxygenation.


Methods. This was a single‐centre, retrospective study of patients admitted to the intensive care unit (ICU) at Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, during the pre‐vaccine COVID‐19 pandemic. Demographics, inflammatory markers (C‐reactive protein (CRP)), organ function (Sequential Organ Failure Assessment (SOFA) score), oxygenation (ratio of partial pressure of oxygen in arterial blood to fraction of inspiratory oxygen (P/F ratio)), overall mortality and complications (nosocomial infections and thromboembolism) were recorded and compared.


Results. We included 113 eligible patients in the study. The IVIg cohort had a significantly lower initial P/F ratio than the SoC cohort (p=0.01), but the change in P/F ratio was similar (p=0.54). Initial CRP and changes in CRP were similar in the two groups (p=0.38 and p=0.75, respectively), as were initial SOFA score and changes in SOFA score (p=0.18 and p=0.08, respectively) and vasopressor dose on day 0 and day 5 (p=0.97 and p=0.93, respectively). Duration of mechanical ventilation did not differ significantly between the IVIg group and the SoC group (p=0.13). There were no significant differences in measured complications between the two groups. On univariate analysis, the relative risk of death was 1.6 times higher (95% confidence interval (CI) 1.1 ‐ 2.3) in the IVIg group; however, a logistical regression model demonstrated that only a higher P/F ratio (odds ratio (OR) 0.991; 95% CI 0.983 ‐ 0.997) and higher mean airway pressure (OR 1.283; 95% CI 1.026 ‐ 1.604) were significantly associated with ICU mortality.


Conclusion. Use of IVIg in our study was directed at an older population, with significantly worse oxygenation. We found no evidence of adverse effects of immunoglobulin therapy; however, we found no benefit either. Only the P/F ratio and mean airway pressure independently predicted ICU mortality.





Article Details

How to Cite
Use of intravenous immunoglobulin for the treatment of severe COVID‐19 in the Chris Hani Baragwanath Academic Hospital intensive care unit, Johannesburg, South Africa. (2024). Southern African Journal of Critical Care, 40(3), e1897. https://doi.org/10.7196/SAJCC.2024.v40i3.1897
Section
Research Articles
Author Biographies

G Mensky, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

1Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa, Registrar

A van Blydenstein, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Pulmonology, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Department of Pulmonology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, South Africa

S Omar, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Critical Care, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Department of Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, South Africa

How to Cite

Use of intravenous immunoglobulin for the treatment of severe COVID‐19 in the Chris Hani Baragwanath Academic Hospital intensive care unit, Johannesburg, South Africa. (2024). Southern African Journal of Critical Care, 40(3), e1897. https://doi.org/10.7196/SAJCC.2024.v40i3.1897

References

1. World Health Organization.

(COVID‐19). https://www.who.int/health‐topics/ coronavirus (accessed 26 November 2023).

2. National Department of Health, South Africa. COVID‐19 online resource and news portal. https://sacoronavirus.co.za/ (accessed 7 June 2023).

3. Roedl K, Jarczak D, Thasler L, et al. Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany. Aust Crit Care 2021;34(2):167‐175. https://doi.org/10.1016/j. aucc.2020.10.009

4. National Department of Health, South Africa. Intravenous immunoglobulin for COVID‐19: Evidence review of potential benefit and harm. 8 April 2020. https://www.health. gov.za/wp‐content/uploads/2020/12/Rapid‐review‐of‐IV‐ Immunoglobulin‐for‐COVID‐19_8April2020.pdf (accessed 6 September 2023).

5. National Institute for Communicable Diseases, South Africa. COVID‐19 hospital surveillance update: Week 48, 2021. https://www.nicd.ac.za/wp‐content/uploads/2021/12/ COVID‐19‐HOSPITAL‐SURVEILLANCE‐UPDATE_ WEEK‐48‐2021_rev.pdf (accessed 28 January 2024).

6. Matthay MA, Arabi Y, Arroliga AC, et al. A new global definition of acute respiratory distress syndrome. Am J Respir Crit Care Med 2024;209(1):37‐47. https://doi. org/10.1164/rccm.202303‐0558WS

7. National Healthcare Safety Network, Centers for Disease Control and Prevention. Bloodstream infection event (central line‐associated bloodstream infection and non‐ central line associated bloodstream infection). January 2024. www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf (accessed 22 October 2024).

8. Hancı P, Uysal A, Yüksel B, İnal V. ROX index dynamics according to high flow nasal cannula success in intensive care unit patients with COVID‐19‐related acute respiratory failure. Balkan Med J 2023;40(2):111‐116. https://doi. org/10.4274/balkanmedj.galenos.2022.2022‐6‐31

9. Esen F, Özcan PE, Orhun G, et al. Effects of adjunct treatment with intravenous immunoglobulins on the course of severe COVID‐19: Results from a retrospective cohort study. Curr Med Res Opin 2021;37(4):543‐548. https://doi. org/10.1080/03007995.2020.185605810. Shao Z, Feng Y, Zhong L, et al. Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID‐19: A multicenter retrospective cohort study. Clin Transl Immunol 2020;9(10):e1192. https://doi.org/10.1002/cti2.1192

11. Mazeraud A, Jamme M, Mancusi RL, et al. Intravenous immunoglobulins in patients with COVID‐19‐associated moderate‐to‐severe acute respiratory distress syndrome (ICAR): Multicentre, double‐blind, placebo‐controlled, phase 3 trial. Lancet Respir Med 2022;10(2):158‐ 166. https://doi.org/10.1016/S2213‐2600(21)00440‐9

12. Sakoulas G, Geriak M, Kullar R, et al. Intravenous immunoglobulin plus methylprednisolone mitigate respiratory morbidity in Coronavirus Disease 2019. Crit Care Explor 2020;2(11):e0280. https://doi.org/10.1097/CCE.0000000000000280

13. Ali HS, Elshafei MS, Saad MO, et al. Clinical outcomes of intravenous immunoglobulin therapy in COVID‐19 related acute respiratory distress syndrome: A retrospective cohort study. BMC Pulm Med 2021;21(1):354. https://doi.org/10.1186/s12890‐021‐01717‐x

14. Liu J, Chen Y, Li R, et al. Intravenous immunoglobulin treatment for patients with severe COVID‐19: A retrospective multicentre study. Clin Microbiol Infect 2021;27(10):1488‐1493. https://doi.org/10.1016/j.cmi.2021.05.012

15. Varikasuvu SR, Varshney S, Dutt N, et al. D‐dimer, disease severity, and deaths (3D‐study) in patients with COVID‐19: A systematic review and meta‐analysis of 100 studies. Sci Rep 2021;11(1):21888. https://doi.org/10.1038/s41598‐021‐01462‐5

16. Marcec R, Dodig VM, Radanovic I, Likic R. Intravenous immunoglobulin (IVIg) therapy in hospitalised adult COVID‐19 patients: A systematic review and meta‐analysis. Rev Med Virol 2022;32(6):e2397. https://doi.org/10.1002/rmv.2397

Similar Articles

You may also start an advanced similarity search for this article.