Treating Critically Ill Patients Experiencing SARS-CoV-2 Severe Infection with Ig-M and Ig-A Enriched Ig-G Infusion

Abstract

SARS-CoV-2 in patients who need intensive care unit (ICU) is associated with a mortality rate ranging from 10 to 40–45%, with an increase in morbidity and mortality in presence of sepsis. We hypothesized that IgM and IgA enriched immunoglobulin G may support the sepsis-related phase improving patient outcome. We conducted a retrospective case–control study on 47 consecutive patients admitted to our ICU. At the time of admission, patients received anticoagulants (heparin sodium) together with the standard supportive treatment. We decided to add IgM and IgA enriched immunoglobulin G to the standard therapy. Patients receiving IgM and IgA enriched immunoglobulin G were compared with patients with similar baseline characteristics and treatment, receiving only standard therapy. The mortality resulted significantly higher in patients treated with standard therapy only (56.5 vs. 37.5%, p < 0.01) and, at day 7, the probability of dying was 3 times higher in this group. Variable life adjustment display (VLAD) was 2.4 and -2.2 (in terms of lives saved in relation with those expected and derived from Simplified Acute Physiology Score II) in the treated and not treated group, respectively. The treatment based on IgM and IgA enriched immunoglobulin G infusion seems to give an advantage on survival in SARS-CoV-2 severe infection.

Clinical Features Related to Severity and Mortality among COVID-19 Patients in a Pre-Vaccine Period in Luanda, Angola

“…Our data show a significant difference in sodium concentration in non-severe vs. severe patients (136 mmol/L vs. 127 mmol/L, p = 0.007), which is in agreement with a study carried out by Guan et al where non-severe COVID-19 patients also showed high sodium [31,32]. In our study, patients who died (131 mmol/L) had higher sodium concentrations compared to surviving patients (128 mmol/L) (p = 0.403), showing that a high concentration of sodium could be a protective biological factor against an unfavorable clinical outcome.…”

“…The higher frequency of patients without antibodies IgG is not surprising, as patients were recruited early after disease onset, presumably without having yet developed a humoral response to infection. The increase in IgG antibodies with the severity of the disease is expected and is in accordance with the profile of the immune response to SARS-CoV-2 infection [30,31]. In agreement with our results, Marklund et al showed that patients with severe COVID-19 seroconvert earlier and develop higher concentrations of SARS-CoV-2specific IgG compared to patients with non-severe disease, which could improve patient outcomes [30].…”

“…Nonetheless, the rate of patients without antibodies (55.6%) who died was higher compared to patients who died despite the presence of antibodies (44.4%), which could indicate that patients who develop IgG antibodies tend to increase their chances of survival. Indeed, a previous study carried out by Corona et al showed that treatment based on an infusion of IgG enriched with IgM and IgA seems to give a survival advantage in cases of severe infection by SARS-CoV-2 [31].…”

A new hope? Possibilities of therapeutic IgA antibodies in the treatment of inflammatory lung diseases

“…Furthermore, there were some case reports and small studies regarding the usage of Pentaglobin as adjunctive therapy in COVID-19 (185)(186)(187)(188). Although in a large retrospective cohort study, no significant difference in mortality was observed (n=316, p=0.374), a subgroup of severe COVID-19 patients who have not yet received invasive mechanical ventilation may benefit from Pentaglobin therapy (p=0.063).…”

Multifaceted Tissue-Protective Functions of Polyvalent Immunoglobulin Preparations in Severe Infections—Interactions with Neutrophils, Complement, and Coagulation Pathways

“…One retrospective case-control study in COVID-19 reported that treatment with an IgM/IgA-enriched Ig preparation significantly (p = 0.045) reduced the number of patients developing septic shock compared with the control group (12.5% (3/24) vs. 21.7% (7/23)) and, accordingly, the mortality rate (Table 2, [175]).…”