Efficacy of Intravenous Immunoglobulin in Patients With Hemorrhagic Fever With Renal Syndrome: a Prospective Study

This is a multicenter, prospective, randomized controlled study which aims at evaluating the efficacy of different doses of IVIG (intravenous immunoglobulin) in the treatment of patients with severe HFRS(hemorrhagic fever with renal syndrome), and providing reference for the future application of IVIG in severe hemorrhagic fever with renal syndrome. This study will include approximately 100 patients with severe hemorrhagic fever with renal syndrome who are randomly assigned to either the IVIG 10g/d group or the IVIG 20g/d group in a 1:1 ratio. The participants in each group will receive treatments for 6 days. Both groups are given routine liquid therapy and symptomatic supportive treatment. The main endpoints include transformation rate, post-period rate, mortality rate, and duration of the disease. Secondary endpoints include the incidence of complications and length of hospital stay.

• IVIG 20g/d (Drug): The dose of IVIG(intravenous immunoglobulin) is 20g/d. Participants also receive conventional liquid therapy and symptomatic and supportive treatment.
• IVIG 10g/d (Drug): The dose of IVIG(intravenous immunoglobulin) is 10g/d. Participants also receive conventional liquid therapy and symptomatic and supportive treatment.

Primary outcomes

• Transformation rate [up to 34th day after treatment]: The transformation rate is defined as the rate of transformation \[critical to severe, moderate or mild, severe to moderate or mild\], or the rate of transition \[severe to critical\].
• Post-period rate [up to 34th day after treatment]: Post-period rate is defined as post-hypotension shock phase or oliguric phase, or post-hypotension shock phase and oliguric phase
• Mortality rate [up to 34th day after treatment]
• The duration of the disease [up to 34th day after treatment]: The duration of the disease is defined as the duration from symptom onset to recovery and discharge.

Secondary outcomes

• The incidence of complications [up to 34th day after treatment]: The incidence of complications is defined as the incidence of shock, renal failure, disseminated intravascular coagulation.
• length of hospital stay [up to 34th day after treatment]: The length of hospital stay is defined as the number of days from admission to discharge.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

The patients must meet all of the following criteria:

* Age ≥ 18 years, regardless of gender;
* Within 5 days of onset, hospitalized patients diagnosed with epidemic hemorrhagic fever (hemorrhagic fever with renal syndrome) must have at least one of the following laboratory test results:

  1. Positive for serum specific IgM(immunoglobulin M) antibodies;
  2. Or detect hantavirus RNA(ribonucleic acid) from patient specimens;
  3. Or the serum specific IgG(immunoglobulin G) antibody titer in the recovery phase is more than four times higher than that in the acute phase;
  4. Or hantavirus can be isolated from patient specimens.
* Meet any of the following criteria:

  1\. Severe illness: meet any of the following criteria: (i) Platelet count 20-50×10\^9/L; (ii) White blood cell count 15-30×10\^9/L. 2. Critical illness: meet any of the following criteria: (i) Platelet count<20×10\^9/L; (ii) White blood cell count>30×10\^9/L.
* Volunteer to join this study and be able to sign or have a written informed consent form signed by a legal representative.

Exclusion Criteria:

Exclude patients who meet any of the following criteria:

* Patients with primary chronic kidney disease;
* Patients with severe diabetes, hypertension, heart, lung, gastrointestinal tract, liver, autoimmune disease or nervous system disease;
* Have a history of malignant tumors (including solid malignant tumors and hematological malignancies etc.);
* Recent use of potentially nephrotoxic drugs;
* Pregnant or potentially pregnant patients;
* Patients with a history of hypersensitivity to IVIG (intravenous immunoglobulin) ;
* Selective IgA(immunoglobulin A) deficiency patients with IgA antibodies;
* Known or suspected immunodeficiency (human immunodeficiency virus infection, primary immunodeficiency), use of immunosuppressive drugs (glucocorticoids);
* Alcoholics, drug abuse, and psychiatric patients
* Other conditions which researchers deem not suitable for inclusion.

• Qin Ning, Professor, Principal investigator, Tongji Hospital