Clinical efficacy of immunoglobulin on the treatment of severe fever with thrombocytopenia syndrome: a retrospective cohort studyResearch in context
Shan-Shan Zhang,
Juan Du,
Ning Cui,
Xin Yang,
Lan Zhang,
Wan-Xue Zhang,
Ming Yue,
Yong-Xiang Wu,
Tong Yang,
Xiao-Ai Zhang,
Zhen-Dong Yang,
Hong-Di Lv,
Qing-Bin Lu,
Wei Liu
Affiliations
Shan-Shan Zhang
Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
Juan Du
Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
Ning Cui
The 154th Hospital, Xinyang, China
Xin Yang
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
Lan Zhang
The 154th Hospital, Xinyang, China
Wan-Xue Zhang
Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
Ming Yue
Department of Infectious Diseases, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
Yong-Xiang Wu
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
Tong Yang
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
Xiao-Ai Zhang
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
Zhen-Dong Yang
The 154th Hospital, Xinyang, China
Hong-Di Lv
The 154th Hospital, Xinyang, China
Qing-Bin Lu
Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China; Corresponding author. Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, 38th Xueyuan Road, Haidian District, Beijing 100191, China.
Wei Liu
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; School of Public Health, Anhui Medical University, Hefei, China; Corresponding author. State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing 100071, China.
Summary: Background: Optimal treatment strategy for severe fever with thrombocytopenia syndrome (SFTS) remained unknown. We aimed to evaluate the efficacy of intravenous immunoglobulin (IVIG) on SFTS. Methods: A retrospective cohort study was conducted based on medical records of the laboratory-confirmed SFTS patients hospitalized during 2010–2020 in the 154th hospital, China. A 1:1 propensity score matching with age, sex, the interval from symptom onset to admission, presence of chronic viral hepatitis, diabetes and disease severity was performed between Non-IVIG group (supportive therapy) and IVIG group (IVIG plus supportive therapy). The matching variables were adjusted to compare the case fatality rates (CFRs), viral load and laboratory parameters between the two groups. Risk ratio (RR) and 95% confidence interval (CI) were reported. Findings: Totally 2219 SFTS patients were recruited. CFRs were significantly higher in 1051 patients in IVIG group than 1168 patients in Non-IVIG group (19.0% vs. 4.6%, RR = 4.30, 95% CI 3.12–5.93). The difference remained significant after matching (17.2% vs. 5.1%, RR = 4.02, 95% CI 2.71–5.97). The CFR of IVIG group was significantly higher in all age groups, two IVIG therapy delay groups and two therapy duration groups compared to that of Non-IVIG group (all P < 0.05). IVIG therapy was related to higher viral loads and reduced counts of lymphocytes, T cells, CD4+ T cells and natural killer cells in the blood (all P < 0.05). Interpretation: No obvious efficacy of IVIG in saving life or improving outcome of SFTS was observed. Caution is needed for clinical physicians to continue prescribing IVIG for SFTS patients. Funding: Natural Science Foundation of China.
