.: ORİJİNAL ARAŞTIRMA
Yoğun Bakım Ünitesinde Yatan Kritik COVID-19 Hastalarında İntravenöz İmmünglobulin Tedavisinin Etkinliği: Retrospektif Kesitsel Bir İnceleme
The Effectiveness of Intravenous Immunoglobulin Therapy in Critically III COVID-19 Patients Hospitalized in the Intensive Care Unit: A Retrospective Cross-Sectional Review
Turkiye Klinikleri J Anest Reanim. 2021;19(3):124-32
doi: 10.5336/anesthe.2021-86334
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Dünya genelinde koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] ile ilgili henüz etkin bir tedavi yöntemi bulunamamışken bu tek merkezli retrospektif çalışmada, yoğun bakım ünitesinde (YBÜ) yatan kritik COVID-19 hastalarında yüksek doz intravenöz immünoglobulin (IVIG) tedavisinin etkinliğini değerlendirmeye çalıştık. Gereç ve Yöntemler: Çalışmaya, YBÜ'lerde takip edilen kritik durumdaki 114 COVID-19 hastası dâhil edildi. Tüm hastalar, 0,5 g/kg/gün dozunda 5 gün IVIG tedavisi aldı. Hastaların tedavi öncesi, tedavinin 3. günü ve tedaviden 48 saat sonraki klinik durum, laboratuvar verileri ve akciğer grafileri karşılaştırıldı. Bulgular: Çalışmaya dâhil edilen hastaların yaş ortalaması 66,83±13,5 gün, YBÜ'de ortalama kalış süreleri 16,5±13,6 gün ve mortalite oranı %78,1 olarak saptandı. Tedavi sonrası 48. saatte yapılan değerlendirmelere göre hastaların %21,9'unda klinik olarak, %28,1'inde ise akciğer bulgularında düzelme saptandı. Laboratuvar değerleri incelendiğinde ise lökosit, nötrofil ve lenfosit sayılarında tedavinin 3. günü gözlenen bir düşüklük olduğu, tedavinin 7. gününde ise bu düşüklüğün yerini yükselişe bıraktığı gözlendi ve bu farkın, istatistiksel olarak anlamlı olduğu saptandı (p değerleri sırasıyla 0,005; 0,016; 0,006). Tedavi sonrasında platelet, C-reaktif protein ve prokalsitonin düzeylerinde anlamlı düşüklük olduğu saptandı (p değerleri sırasıyla <0,001, <0,001, 0,005). Sonuç: Yüksek doz IVIG tedavisinin, YBÜ'de yatan kritik COVID-19 hastalarında inflamatuar yanıtı azalttığı ancak mortaliteyi azalmada yeterli etkinlikte olmadığı saptanmıştır.
Anahtar Kelimeler: COVID-19; immünmodülasyon; intravenöz immünglobulin; yoğun bakım ünitesi
Amaç: Dünya genelinde koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] ile ilgili henüz etkin bir tedavi yöntemi bulunamamışken bu tek merkezli retrospektif çalışmada, yoğun bakım ünitesinde (YBÜ) yatan kritik COVID-19 hastalarında yüksek doz intravenöz immünoglobulin (IVIG) tedavisinin etkinliğini değerlendirmeye çalıştık. Gereç ve Yöntemler: Çalışmaya, YBÜ'lerde takip edilen kritik durumdaki 114 COVID-19 hastası dâhil edildi. Tüm hastalar, 0,5 g/kg/gün dozunda 5 gün IVIG tedavisi aldı. Hastaların tedavi öncesi, tedavinin 3. günü ve tedaviden 48 saat sonraki klinik durum, laboratuvar verileri ve akciğer grafileri karşılaştırıldı. Bulgular: Çalışmaya dâhil edilen hastaların yaş ortalaması 66,83±13,5 gün, YBÜ'de ortalama kalış süreleri 16,5±13,6 gün ve mortalite oranı %78,1 olarak saptandı. Tedavi sonrası 48. saatte yapılan değerlendirmelere göre hastaların %21,9'unda klinik olarak, %28,1'inde ise akciğer bulgularında düzelme saptandı. Laboratuvar değerleri incelendiğinde ise lökosit, nötrofil ve lenfosit sayılarında tedavinin 3. günü gözlenen bir düşüklük olduğu, tedavinin 7. gününde ise bu düşüklüğün yerini yükselişe bıraktığı gözlendi ve bu farkın, istatistiksel olarak anlamlı olduğu saptandı (p değerleri sırasıyla 0,005; 0,016; 0,006). Tedavi sonrasında platelet, C-reaktif protein ve prokalsitonin düzeylerinde anlamlı düşüklük olduğu saptandı (p değerleri sırasıyla <0,001, <0,001, 0,005). Sonuç: Yüksek doz IVIG tedavisinin, YBÜ'de yatan kritik COVID-19 hastalarında inflamatuar yanıtı azalttığı ancak mortaliteyi azalmada yeterli etkinlikte olmadığı saptanmıştır.
Anahtar Kelimeler: COVID-19; immünmodülasyon; intravenöz immünglobulin; yoğun bakım ünitesi
ABSTRACT
Objective: While an effective treatment method for coronavirus disease-2019 (COVID-19) has not yet been found worldwide, we tried to evaluate the efficacy of high-dose intravenous immunoglobulin (IVIG) therapy in critically ill COVID-19 patients in the intensive care unit (ICU) in this single-center retrospective study. Material and Methods: This study included 114 critically ill patients with COVID-19 followed in ICUs. All patients received IVIG treatment at a dose of 0.5 g/kg/day for 5 days. The clinical status, laboratory data and chest X-rays of the patients before the treatment, on the 3rd day of the treatment and 48 hours after the treatment were compared. Results: The mean age of the patients included in the study was 66.83±13.5 days, the mean length of stay in the ICU was 16.5±13.6 days, and the mortality rate was 78.1%. According to the evaluations made at the 48th hour after treatment, clinical improvement was detected in 21.9% of the patients, while lung findings were improved in 28.1%. When the laboratory values were examined, it was observed that there was a decrease observed in the leukocyte, neutrophil and lymphocyte counts on the 3rd day of the treatment, and this decrease was replaced by an increase in the 7th day of the treatment, and this difference was found to be statistically significant (p values 0.005; 0.016; 0.006). After the treatment, it was determined that there was a significant decrease in platelet, C-reactive protein and procalcitonin levels (p values respectively <0.001, <0.001, 0.005). Conclusion: As a result of the study, it was observed that high-dose IVIG treatment reduced the inflammatory response in critically ill COVID-19 patients hospitalized in the ICU, but was not effective enough to reduce mortality.
Keywords: COVID-19; immunomodulation; intravenous immunoglobulin; intensive care unit
Objective: While an effective treatment method for coronavirus disease-2019 (COVID-19) has not yet been found worldwide, we tried to evaluate the efficacy of high-dose intravenous immunoglobulin (IVIG) therapy in critically ill COVID-19 patients in the intensive care unit (ICU) in this single-center retrospective study. Material and Methods: This study included 114 critically ill patients with COVID-19 followed in ICUs. All patients received IVIG treatment at a dose of 0.5 g/kg/day for 5 days. The clinical status, laboratory data and chest X-rays of the patients before the treatment, on the 3rd day of the treatment and 48 hours after the treatment were compared. Results: The mean age of the patients included in the study was 66.83±13.5 days, the mean length of stay in the ICU was 16.5±13.6 days, and the mortality rate was 78.1%. According to the evaluations made at the 48th hour after treatment, clinical improvement was detected in 21.9% of the patients, while lung findings were improved in 28.1%. When the laboratory values were examined, it was observed that there was a decrease observed in the leukocyte, neutrophil and lymphocyte counts on the 3rd day of the treatment, and this decrease was replaced by an increase in the 7th day of the treatment, and this difference was found to be statistically significant (p values 0.005; 0.016; 0.006). After the treatment, it was determined that there was a significant decrease in platelet, C-reactive protein and procalcitonin levels (p values respectively <0.001, <0.001, 0.005). Conclusion: As a result of the study, it was observed that high-dose IVIG treatment reduced the inflammatory response in critically ill COVID-19 patients hospitalized in the ICU, but was not effective enough to reduce mortality.
Keywords: COVID-19; immunomodulation; intravenous immunoglobulin; intensive care unit
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