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Immunoglobulin Deficiency as an Indicator of Disease Severity in Patients with COVID-19
American Journal of Physiology-Lung Cellular and Molecular Physiology ( IF 4.9 ) Pub Date : 2020-11-25 , DOI: 10.1152/ajplung.00359.2020
Faeq Husain-Syed 1, 2, 3 , István Vadász 2, 4, 5 , Jochen Wilhelm 4, 5, 6 , Hans-Dieter Walmrath 1, 2, 7 , Werner Seeger 1, 2, 4, 5, 7 , Horst-Walter Birk 1 , Birgit Jennert 1 , Hartmut Dietrich 1 , Susanne Herold 2, 4, 5, 7 , Janina Trauth 7 , Khodr Tello 2, 4, 5 , Michael Sander 8 , Rory E. Morty 2, 4, 5, 9 , Heiko Slanina 10 , Christian G. Schüttler 10 , John Ziebuhr 10 , Shadi Kassoumeh 11 , Claudio Ronco 3, 12 , Fiorenza Ferrari 13 , Klaus Warnatz 14 , Klaus Stahl 15 , Benjamin Seeliger 16 , Marius M. Hoeper 16 , Tobias Welte 16 , Sascha David 17, 18
Affiliation  

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 critical ill COVID-19 patients admitted to two German ICUs (72.6% male, median age: 61 years). 13 (21.0%) of the patients displayed IgG deficiency (IgG <7 g/L) at baseline (predominant for the IgG1, IgG2, and IgG4 subclasses). IgG-deficient patients had worse measures of clinical disease severity than those with normal IgG levels (shorter duration from disease onset to ICU admission, lower ratio of PaO2 to FiO2, higher Sequential Organ Failure Assessment score, and higher levels of ferritin, neutrophil-to-lymphocyte ratio and serum creatinine). IgG-deficient patients were also more likely to have sustained lower levels of lymphocyte counts and higher levels of ferritin throughout the hospital stay. Furthermore, IgG-deficient patients compared to those with normal IgG levels displayed higher rates of acute kidney injury (76.9% vs. 26.5%; p=0.005) 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). Multivariable logistic regression showed increasing odds of 90-day overall mortality associated with IgG-deficiency (OR 12.8, 95% CI 1.5-108.4; p=0.019). IgG deficiency might be common in critically ill COVID-19 patients, and warrants investigation as both a marker of disease severity as well as a potential therapeutic target.

中文翻译:

免疫球蛋白缺乏症可作为COVID-19患者疾病严重程度的指标

尽管COVID-19处于大流行状态,但除支持治疗外,关于宿主危险因素和治疗的信息有限。免疫球蛋白G(IgG)可能是潜在的治疗目标。我们的目的是确定在德国的两家重症监护病房(男性占72.6%,中位年龄:61岁)的62名重症COVID-19患者中的IgG缺乏症及相关危险因素的发生率。13名患者(21.0%)在基线时表现出IgG缺乏症(IgG <7 g / L)(主要针对IgG1,IgG2和IgG4亚类)。缺乏IgG的患者比具有正常IgG水平的患者对临床疾病严重程度的衡量标准更差(从疾病发作到ICU入院的持续时间较短,PaO 2与FiO 2的比率较低,更高的顺序器官衰竭评估得分,以及更高的铁蛋白,中性粒细胞与淋巴细胞比例和血清肌酐水平)。缺乏IgG的患者在整个住院期间也更有可能持续降低淋巴细胞计数水平和提高铁蛋白水平。此外,与IgG水平正常的患者相比,IgG缺乏的患者急性肾损伤的发生率更高(76.9%vs. 26.5%; p = 0.005)和死亡(46.2%vs. 14.3%; p = 0.012),ICU更长( 28 [6-48]天vs. 12 [3-18]天; p = 0.012)和住院时间(30 [22-50] vs. 18 [9-24]天; p = 0.004)。多变量logistic回归显示与IgG缺乏相关的90天总死亡率的可能性增加(OR 12.8,95%CI 1.5-108.4; p = 0.019)。IgG缺乏症在重症COVID-19患者中可能很常见,
更新日期:2020-11-27
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