Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications

Yun Liu; Hanwen Tong; Fei He; Yu Zhai; Chao Wu; Jun Wang; Chenxiao Jiang

doi:10.3389/fimmu.2023.1118039

Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications

Front Immunol. 2023 Mar 22:14:1118039. doi: 10.3389/fimmu.2023.1118039. eCollection 2023.

Authors

Yun Liu¹, Hanwen Tong¹, Fei He¹, Yu Zhai¹, Chao Wu², Jun Wang¹, Chenxiao Jiang³

Affiliations

¹ Department of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
² Department of Infectious Disease, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
³ Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.

Abstract

Background: Intravenous immunoglobulin (IVIG) has been reported to exert a beneficial effect on severe fever with thrombocytopenia syndrome (SFTS) patients with neurological complications. However, in clinical practice, the standard regime is unclear and there is a lack of evidence from large-scale studies.

Methods: A single-center retrospective study was conducted to determine the influence of IVIG dosage and duration on SFTS patients with neurological complications. The primary outcome was 28-day mortality, and laboratory parameters before and after IVIG treatment were measured. Survival curves were generated using the Kaplan-Meier method and analyzed with the log-rank test according to the median IVIG dosage and IVIG duration. Besides, multivariate Cox regression analysis was performed to examine the association between the independent factors and 28-day mortality in SFTS patients.

Results: Overall, 36 patients (58.06%) survived, while 26 (41.9%) patients died. The median age of the included patients was 70 (55-75) years, and 46.8% (29/62) were male. A significantly higher clinical presentation of dizziness and headache was observed in the survival group. The IVIG duration in the survival group was longer than in the death group (P <0.05). Additionally, the IVIG dosage was higher in the survival group than in the death group, but there was not a statistically significant difference between the two groups (P = 0.066). The mediating effect of IVIG duration was verified through the relationship between IVIG dosage and prognosis using the Sobel test. Univariate analysis revealed that IVIG dosage (HR: 0.98; 95% CI: 0.97-1.00; P = 0.007) and IVIG duration (HR: 0.54; 95% CI: 0.41-0.72; P <0.001) were significantly associated with risk of death. The multivariate analysis generated an adjusted HR value of 0.98 (95% CI: 0.96-1.00; P = 0.012) for IVIG dosage and 0.26 (95% CI: 0.09-0.78; P = 0.016) for dizziness and headache.

Conclusion: Prolonged high-dose IVIG is beneficial to the 28-day prognosis in SFTS patients with neurological complications.

Keywords: dosage; duration; intravenous immunoglobulin; mortality; neurological complications; severe fever with thrombocytopenia syndrome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Dizziness / drug therapy
Female
Headache / drug therapy
Humans
Immunoglobulins, Intravenous* / therapeutic use
Male
Prognosis
Retrospective Studies
Severe Fever with Thrombocytopenia Syndrome*

Substances

Immunoglobulins, Intravenous

Grants and funding

This study was funded by the Jiangsu Research Hospital Association for Precision Medication (No. JY202120), the Jiangsu Pharmaceutical Association for Jinpeiying Project (No. J2021001), and the Nanjing Medical Center for Clinical Pharmacy (No.15).