Early therapy with IgM-enriched polyclonal immunoglobulin in patients with septic shock
- 1.4k Downloads
To determine whether there was an association between adjunctive therapy with IgM-enriched immunoglobulin (IgM) and the 30-day mortality rate in patients with septic shock.
In 2008 we introduced IgM as a possible adjunctive therapy to be provided within 24 h after shock onset in the management protocol for patients with septic shock. In this retrospective study we included the adult patients suitable for IgM therapy admitted to our ICU from January 2008 to December 2011. An unadjusted comparison between patients who did or did not receive IgM therapy, a multivariate logistic model adjusted for confounders and propensity score-based matching were used to evaluate the association between early IgM treatment and mortality.
One hundred and sixty-eight patients were included in the study. Of these, 92 (54.8 %) received IgM therapy. Patients who did or did not receive IgM were similar with regards to infection characteristics, severity scores and sepsis treatment bundle compliance. Patients who received IgM were more likely to have blood cultures before antibiotics and to attain a plateau inspiratory pressure less than 30 cmH2O (p < 0.05). The 30-day mortality rate was reduced by 21.1 % (p < 0.05) in the group that received IgM compared to the group that did not. The multivariate adjusted regression model (OR 0.17; CI 95 % 0.06–0.49; p = 0.001) and the propensity score-based analysis (OR 0.35; CI 95 % 0.14–0.85; p = 0.021) confirmed that IgM therapy was associated with reduced mortality at 30 days after the onset of septic shock.
Our experience indicates that early adjunctive treatment with IgM may be associated with a survival benefit in patients with septic shock. However, additional studies are needed to better evaluate the role of IgM therapy in the early phases of septic shock.
KeywordsSepsis Immunoglobulin Shock Sepsis bundles Intensive care
We wish to thank Mervyn Singer and Matteo Bassetti for critical revisions of the manuscript and their clever suggestions.
Conflicts of interest
Cavazzuti Ilaria and Massimo Girardis have consulted for Biotest-Germany, the remaining authors have no competing interests.
- 3.Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al (2013) Surviving sepsis campaign guidelines committee including the pediatric subgroup: surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Intensive Care Med 39:165–228PubMedCrossRefGoogle Scholar
- 5.Reinhart K, Brunkhorst FM, Bone H-G, Bardutzky J, Dempfle C-E, Forst H et al (2010) Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2 k guidelines of the German Sepsis Society [Deutsche Sepsis-Gesellschaft e.V. (DSG)] and the German Interdisciplinary Association of Intensive Care and Emergency Medicine [Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI)]. Ger Med Sci 8Google Scholar
- 10.Alejandria MM, Lansang MA, Dans LF, Mantaring JB 3rd (2013) Intravenous immunoglobulin for treating sepsis and septic shock. Cochrane Database Syst 9:CD001090Google Scholar
- 14.Girardis M, Rinaldi L, Donno L, Marietta M, Codeluppi M, Marchegiano P et al (2009) Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: a pilot study. Crit Care 13:R143PubMedCentralPubMedCrossRefGoogle Scholar
- 19.Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H et al (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care MedicinePubMedCrossRefGoogle Scholar
- 20.Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG et al (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18:268–281PubMedCrossRefGoogle Scholar
- 21.Rosenbaum PR, Rubin DB (1985) Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 39:33–38Google Scholar
- 22.Soares MO, Welton NJ, Harrison DA, Peura P, Shankar-Hari M, Harvey SE et al (2012) An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of information analysis. Health Technol Assess 16:1–186CrossRefGoogle Scholar
- 30.Cavazzutti I, Rinaldi L, Braccini S, Bertolotti V, Andreotti A, Busani S et al (2009) Effects of intravenous IgM-enriched immunoglobulins on muscle tissue microcirculation in septic shock: a preliminary report. Intensive Care Med 35:s239Google Scholar
- 31.Yavuz L, Aynali G, Aynali A, Alaca A, Kutuk S, Ceylan BG (2012) The effects of adjuvant immunoglobulin M-enriched immunoglobulin therapy on mortality rate and renal function in sepsis-induced multiple organ dysfunction syndrome: retrospective analysis of intensive care unit patients. J Int Med Res 40:1166–1174PubMedCrossRefGoogle Scholar
- 34.Berlot G, Vassallo MC, Busetto N, Bianchi M, Zornada F, Rosato I et al (2012) Relationship between the timing of administration of IgM and IgA enriched immunoglobulins in patients with severe sepsis and septic shock and the outcome: a retrospective analysis. J Crit Care 27:167–171PubMedCrossRefGoogle Scholar