Impact of Hypogammaglobulinemia on the Course of COVID-19 in a Non-Intensive Care Setting: A Single-Center Retrospective Cohort Study

Abstract

BackgroundSeverity and mortality of COVID-19 largely depends on the ability of the immune system to clear the virus. Among various comorbidities potentially impacting on this process, the weight and the consequences of an antibody deficiency have not yet been clarified.MethodsWe used serum protein electrophoresis to screen for hypogammaglobulinemia in a cohort of consecutive adult patients with COVID-19 pneumonia, hospitalized in non-intensive care setting between December 2020 and January 2021. The disease severity, measured by a validated score and by the need for semi intensive (sICU) or intensive care unit (ICU) admission, and the 30-day mortality was compared between patients presenting hypogammaglobulinemia (HYPO) and without hypogammaglobulinemia (no-HYPO). Demographics, comorbidities, COVID-19 specific treatment during the hospital stay, disease duration, complications and laboratory parameters were also evaluated in both groups.ResultsWe enrolled 374 patients, of which 39 represented the HYPO cohort (10.4%). In 10/39 the condition was previously neglected, while in the other 29/39 hematologic malignancies were common (61.5%); 2/39 were on regular immunoglobulin replacement therapy (IgRT). Patients belonging to the HYPO group more frequently developed a severe COVID-19 and more often required sICU/ICU admission than no-HYPO patients. IgRT were administered in 8/39 during hospitalization; none of them died or needed sICU/ICU. Among HYPO cohort, we observed a significantly higher prevalence of neoplastic affections, of active oncologic treatment and bronchiectasis, together with higher prevalence of viral and bacterial superinfections, mechanical ventilation, convalescent plasma and SARS-CoV-2 monoclonal antibodies administration during hospital stay, and longer disease duration. Multivariate logistic regression analysis and Cox proportional hazard regression confirmed the impact of hypogammaglobulinemia on the COVID-19 severity and the probability of sICU/ICU admission. The analysis of the mortality rate in the whole cohort showed no significant difference between HYPO and no-HYPO.ConclusionsHypogammaglobulinemia, regardless of its cause, in COVID-19 patients hospitalized in a non-intensive care setting was associated to a more severe disease course and more frequent admission to s-ICU/ICU, particularly in absence of IgRT. Our findings emphasize the add-value of routine serum protein electrophoresis evaluation in patients admitted with COVID-19 to support clinicians in patient care and to consider IgRT initiation during hospitalization.

Hypoalbuminemia, Hyper-a-1/–a-2-Globulinemia Associated with High CRP and IL-6 in COVID-19 Patients in Togo

“…So, in presence of an increase of CRP level, a decrease of albumin and γ-globulin levels leads to a chance of having an asymptomatic status. In contrast with our results, several authors noticed that low level of serum albumin is a predictor of vulnerability to COVID-19 [45,46] and hypogammaglobulinemia associated to a poor outcome in COVID-19 patients hospitalized in a nonintensive care setting [47]. This contradiction may be justified by the difference in sample sizes or by the location of study site.…”

Hypogammaglobulinemia and Infection Risk in an Ocrelizumab-treated Multiple Sclerosis Cohort

“…25,31 While there are no current specific MS studies looking at hypogammaglobulinemia's impact on SARS-CoV-2 evolution, small non-MS cohorts do suggest higher rates of severe infection, superinfections, need for mechanical ventilation and prolonged disease course. 32 While our cohort had low rates of SARS-CoV-2 infection, likely in the context of heightened precautionary measures and the timing of the data collection, we believe this further emphasizes the importance of monitoring immunoglobulin levels, especially in people with MS treated on ocrelizumab who are experiencing recurrent and/or severe infections.…”

Predictive factors of the presence of pulmonary embolism in patients with interstitial lung disease: Observational study

“…A previous report indicated a lower incidence of thromboembolism in patients with hypogammaglobulinemia (2.6%) than in those without hypogammaglobulinemia (5.7%) among individuals with coronavirus disease 2019 infection, although statistical significance was not reached due to the small sample size. [ 31 ] While we hypothesize that low serum TP levels, including globulin, might suppress the development of VTE in patients with ILD, there is currently insufficient evidence to substantiate this hypothesis. Further research is needed to elucidate the specific mechanisms underlying the association between PE and serum TP levels.…”