Clinical efficacy of immunoglobulin in pediatric patients with severe respiratory syncytial virus pneumonia: a retrospective clinical analysis.

BACKGROUND

The effectiveness of intravenous immunoglobulin (IVIG) in the treatment of severe respiratory syncytial virus pneumonia (SRSVP) remains a topic of ongoing debate. This study aimed to evaluate the association of IVIG on the duration of hospitalization and the use of corticosteroids in pediatric cases of SRSVP.

METHODS

To minimize confounding by indication, a 1:1 propensity score matching (PSM) was performed with a caliper width of 0.02. Multivariate logistic regression analysis was conducted for the entire cohort (n = 157), while generalized estimating equations (GEE) /generalized linear models (GZLM) were utilized within the matched cohort to evaluate the independent association between IVIG use and clinical outcomes (hospitalization duration and corticosteroid use).

RESULTS

Results showed that intravenous immunoglobulin (IVIG) treatment failed to reduce the duration of corticosteroid use, corticosteroid dosage, or length of hospital stay (OR = 4.634; OR = 4.667; OR = 2.566). Propensity score matching (PSM) successfully generated 41 well-balanced pairs. In the GEE/GZLM analysis (which further corrected for residual baseline imbalances in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatinine), IVIG treatment still failed to reduce the duration of glucocorticoid use (OR = 3.229, 95% CI: 1.267-8.232), reduce glucocorticoid dosage (OR = 2.653, 95% CI: 1.063-6.619), or shorten the length of hospital stay (OR = 4.375, 95% CI: 1.581-12.108). Furthermore, subgroup analysis showed that in infants <6 months of age, IVIG treatment did not shorten hospital stay and was not associated with glucocorticoid use outcomes.

CONCLUSION

In conclusion, intravenous immunoglobulin (IVIG) treatment did not shorten hospital stays or reduce the use of glucocorticoids in children with severe respiratory syncytial virus pneumonia (SRSVP). Therefore, it is necessary to reassess the value of IVIG in the treatment of SRSVP.