Association of Intravenous Immunoglobulin Therapy with Coagulation Dynamics and Clinical Outcomes in Patients with ARDS: A Single-Center Study in Azerbaijan

Öz

Abstract

Introduction:
Acute respiratory distress syndrome (ARDS) remains a severe clinical condition in intensive care practice, characterized by high morbidity and mortality. ARDS is not limited to respiratory failure alone but is also accompanied by a systemic inflammatory response, endothelial dysfunction, and activation of the coagulation system. Although intravenous immunoglobulin (IVIG) therapy has attracted attention as an immunomodulatory approach in critical illness, its relationship with coagulation dynamics in patients with ARDS has not been sufficiently investigated.

Materials and methods:   

This retrospective, single-center cohort study was conducted in the intensive care unit of the Baku Medical Plaza Babek branch. Patients aged 18 years and older who were diagnosed with ARDS according to the Berlin criteria and treated between January 1, 2015 and December 31, 2020 were included in the study. Patients were divided into two groups: those receiving standard treatment alone and those receiving IVIG in addition to standard treatment. IVIG was administered at a dose of 0.4 g/kg/day for 5 days. Coagulation parameters, including the international normalized ratio (INR) and D-dimer levels, were assessed at treatment initiation and on days 3, 5, 7, and 10. Survival was analyzed as an exploratory clinical outcome.

Results:
A total of 89 patients were included in the study (IVIG group n=26, control group n=63). At baseline, INR and D-dimer values were similar between the groups. From day 3 of treatment onward, the IVIG group demonstrated more stable and consistent changes in INR over time, with statistically significant differences observed at several consecutive time points. D-dimer levels showed a declining trend in both groups, but no statistically significant differences were recorded between the groups. Logistic regression analysis for survival showed a statistically non-significant association between IVIG therapy and an increased probability of survival.

Conclusion:
In patients with ARDS, intravenous immunoglobulin therapy was associated with the temporal dynamics of coagulation parameters, particularly INR. Although the findings regarding D-dimer and survival were not statistically conclusive, the observed trends do not rule out a potential effect of IVIG on coagulation balance. These findings provide a basis for evaluating IVIG as an additional immunomodulatory approach in the treatment of ARDS and highlight the importance of future prospective studies. Although the observed INR changes did not exceed clinically critical thresholds, they may reflect a more stable course of coagulation balance.