Abstract Objective Coronavirus disease 2019 (COVID‐19) outbreak is a major challenge all over the world, without acknowledged treatment. Intravenous immunoglobulin (IVIG) has been recommended to treat critical coronavirus disease 2019 (COVID‐19) patients in a few reviews, but the clinical study evidence on its efficacy in COVID‐19 patients was lacking. Methods 325 patients with laboratory‐confirmed critical COVID‐19 were enrolled from 4 government‐designated COVID‐19 treatment centres in southern China from December 2019 to March 2020. The primary outcomes were 28‐ and 60‐day mortality, and the secondary outcomes were the total length of in‐hospital and the total duration of the disease. Subgroup analysis was carried out according to clinical classification of COVID‐19, IVIG dosage and timing. Results In the enrolled 325 patients, 174 cases used IVIG and 151 cases did not. The 28‐day mortality was improved with IVIG after adjusting confounding in overall cohort ( P = 0.0014), and the in‐hospital and the total duration of disease were longer in the IVIG group ( P < 0.001). Subgroup analysis showed that only in patients with critical type, IVIG could significantly reduce the 28‐day mortality, decrease the inflammatory response and improve some organ functions (all P < 0.05); the application of IVIG in the early stage (admission ≤ 7 days) with a high dose (> 15 g per day) exhibited significant reduction in 60‐day mortality in the critical‐type patients. Conclusion Early administration of IVIG with high dose improves the prognosis of critical‐type patients with COVID‐19. This study provides important information on clinical application of IVIG in the treatment of SARS‐CoV‐2 infection, including patient selection and administration dosage and timing. Early administration of a high dose of intravenous immunoglobulin (IVIG) improves the prognosis of critical‐type patients with COVID‐19. This study provides important information on clinical application of IVIG in the treatment of SARS‐CoV‐2 infection, including patient selection and administration dosage and timing.
【저자키워드】 COVID‐19, Mortality, SARS‐CoV‐2, IVIG, Clinical efficacy, 【초록키워드】 Treatment, coronavirus disease, Coronavirus disease 2019, Intravenous immunoglobulin, Efficacy, High dose, Prognosis, COVID‐19, China, Cohort, Immunoglobulin, outbreak, Patient, information, disease, Critical, early stage, patients, clinical study, Evidence, Inflammatory response, administration, Analysis, Primary outcome, dosage, secondary outcome, treat, SARS‐CoV‐2 infection, patient selection, organ function, objective, decrease, IMPROVE, Result, enrolled, carried, significantly, the disease, exhibited, per day, provide, reduce, reduction in, COVID‐19 patient, 【제목키워드】 Intravenous immunoglobulin, Efficacy, therapy, clinical, multicenter, Critical, retrospective cohort study, ill patient,