Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications
BackgroundIntravenous 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 st...
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| Format: | Article |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1118039/full |
| _version_ | 1797221124700897280 |
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| author | Yun Liu Hanwen Tong Fei He Yu Zhai Chao Wu Jun Wang Chenxiao Jiang |
| author_facet | Yun Liu Hanwen Tong Fei He Yu Zhai Chao Wu Jun Wang Chenxiao Jiang |
| author_sort | Yun Liu |
| collection | DOAJ |
| description | BackgroundIntravenous 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.MethodsA 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.ResultsOverall, 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.ConclusionProlonged high-dose IVIG is beneficial to the 28-day prognosis in SFTS patients with neurological complications. |
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| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-04-24T13:00:27Z |
| publishDate | 2023-03-01 |
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| spelling | doaj.art-1ad8b2e98df74dfcb97c51b42be5366b2024-04-05T11:52:42ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-03-011410.3389/fimmu.2023.11180391118039Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complicationsYun Liu0Hanwen Tong1Fei He2Yu Zhai3Chao Wu4Jun Wang5Chenxiao Jiang6Department of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, ChinaDepartment of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, ChinaDepartment of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, ChinaDepartment of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, ChinaDepartment of Infectious Disease, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, ChinaDepartment of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, ChinaDepartment of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, ChinaBackgroundIntravenous 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.MethodsA 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.ResultsOverall, 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.ConclusionProlonged high-dose IVIG is beneficial to the 28-day prognosis in SFTS patients with neurological complications.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1118039/fullintravenous immunoglobulinmortalitysevere fever with thrombocytopenia syndromeneurological complicationsdosageduration |
| spellingShingle | Yun Liu Hanwen Tong Fei He Yu Zhai Chao Wu Jun Wang Chenxiao Jiang Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications Frontiers in Immunology intravenous immunoglobulin mortality severe fever with thrombocytopenia syndrome neurological complications dosage duration |
| title | Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications |
| title_full | Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications |
| title_fullStr | Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications |
| title_full_unstemmed | Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications |
| title_short | Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications |
| title_sort | effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications |
| topic | intravenous immunoglobulin mortality severe fever with thrombocytopenia syndrome neurological complications dosage duration |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1118039/full |
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