Skip to main content

Immunoglobulin as Adjunctive Therapy in Sepsis

  • Conference paper
  • First Online:
Anaesthesia, Pharmacology, Intensive Care and Emergency A.P.I.C.E.

Abstract

Mortality in patients admitted to hospital with severe sepsis and septic shock is still unacceptably high, despite advances in understanding of the pathophysiological mechanisms and the implementation of evidence-based guidelines. Severe sepsis is often associated with the decrease in immunoglobulin plasma levels (Ig) and the presence of hypogammaglobulinaemia is related to bad outcome. Ig plays a pivotal role in immune and inflammatory response and therapy with intravenous Ig is currently recommended in several no septic diseases. Diverse meta-analysis showed that the adjunctive therapy with intravenous polyclonal Ig, particularly with preparation enriched in IgM component, may be beneficial also in patients with severe sepsis and septic shock.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Abbreviations

SSC =:

Surviving Sepsis Campaign

ICU =:

Intensive Care Unit

SIRS =:

Systemic Inflammatory Response Syndrome

IgG/IgM =:

Immunoglobulin G/M

IgGAM =:

Immunoglobulin IgM enriched

SSP =:

Sepsis Stewardship Program

SOFA =:

Sequential Organ Failure Assessment

SAPS =:

Simplified Acute Physiology Score

RCT =:

Randomized Controlled Trial

CVP =:

Central Venous Pressure

SvcO2 =:

Central Venous Oxygen Saturation

ALI =:

Acute Lung Injury

ARDS =:

Acute Respiratory Distress Syndrome

rhAPC =:

recombinant human Activated C Protein

References

  1. Malacarne P, Langer M, Nascimben E et al (2008) Building a continuous multicenter infection surveillance system in the intensive care unit: findings from the initial data set of 9,493 patients from 71 Italian intensive care units. Crit Care Med 36(4):1105–1113

    Article  PubMed  Google Scholar 

  2. Dellinger RP, Levy MM, Carlet JM et al (2008) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36(1):296–327

    Article  PubMed  Google Scholar 

  3. Dellinger RP, Levy MM, Rhodes A et al (2012) (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med 39(2):165–228

    Article  Google Scholar 

  4. Barochia AV, Cui X, Vitberg D et al (2010) Bundled care for septic shock: an analysis of clinical trials. Crit Care Med 38(2):668–678

    Article  PubMed  Google Scholar 

  5. Reinhart K, Brunkhorst FM, Bone H-G 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. Gms E-J.8:Doc14

    Google Scholar 

  6. Taccone FS, Stordeur P, De Backer D (2009) Gamma-globulin levels in patients with community-acquired septic shock. Shock Augusta Ga. 32(4):379–385

    Article  CAS  Google Scholar 

  7. Venet F, Gebeile R, Bancel J et al (2011) Assessment of plasmatic immunoglobulin G, A and M levels in septic shock patients. Int Immunopharmacol 11(12):2086–2090

    Article  PubMed  CAS  Google Scholar 

  8. Walpen AJ, Laumonier T, Aebi C (2004) Immunoglobulin M-enriched intravenous immunoglobulin inhibits classical pathway complement activation, but not bactericidal activity of human serum. Xenotransplantation 11(2):141–148

    Article  PubMed  Google Scholar 

  9. Norrby-Teglund A, Haque KN, Hammarström L (2006) Intravenous polyclonal IgM-enriched immunoglobulin therapy in sepsis: a review of clinical efficacy in relation to microbiological aetiology and severity of sepsis. J Intern Med 260(6):509–516

    Article  PubMed  CAS  Google Scholar 

  10. Trautmann M, Held TK, Susa M et al (1998) Bacterial lipopolysaccharide (LPS)-specific antibodies in commercial human immunoglobulin preparations: superior antibody content of an IgM-enriched product. Clin Exp Immunol 111(1):81–90

    Article  PubMed  CAS  Google Scholar 

  11. Ehrenstein MR, Notley CA (2010) The importance of natural IgM: scavenger, protector and regulator. Nat Rev Immunol 10(11):778–786

    Article  PubMed  CAS  Google Scholar 

  12. Wenisch C, Parschalk B, Patruta S (1999) Effect of polyclonal immunoglobulins on neutrophil phagocytic capacity and reactive oxygen production in patients with gram-negative septicemia. Infection 27(3):183–186

    Article  PubMed  CAS  Google Scholar 

  13. Autenrieth IB, Schwarzkopf A, Ewald JH (1995) Bactericidal properties of Campylobacter jejuni-specific immunoglobulin M antibodies in commercial immunoglobulin preparations. Antimicrob Agents Chemother 39(9):1965–1969

    Article  PubMed  CAS  Google Scholar 

  14. Schedel I, Dreikhausen U, Nentwig B et al (1991) Treatment of gram-negative septic shock with an immunoglobulin preparation: A prospective, randomized clinical trial. Crit Care Med 19(9):1104–1113

    Article  PubMed  CAS  Google Scholar 

  15. Tugrul S, Ozcan PE, Akinci O et al (2002) The effects of IgM-enriched immunoglobulin preparations in patients with severe sepsis [ISRCTN28863830]. Crit. Care Lond. Engl. 6(4):357–362

    Article  Google Scholar 

  16. Karatzas S, Boutzouka E, Venetsanou K (2002) The effects of IgM-enriched immunoglobulin preparations in patients with severe sepsis: another point of view. Crit. Care Lond. Engl. 6(6):543–544; author reply 545

    Google Scholar 

  17. Rodríguez A, Rello J, Neira J et al (2005) Effects of high-dose of intravenous immunoglobulin and antibiotics on survival for severe sepsis undergoing surgery. Shock Augusta Ga. 23(4):298–304

    Article  Google Scholar 

  18. Hentrich M, Fehnle K, Ostermann H et al (2006) IgMA-enriched immunoglobulin in neutropenic patients with sepsis syndrome and septic shock: a randomized, controlled, multiple-center trial. Crit Care Med 34(5):1319–1325

    Article  PubMed  CAS  Google Scholar 

  19. Turgeon AF, Hutton B, Fergusson DA et al (2007) Meta-analysis: intravenous immunoglobulin in critically ill adult patients with sepsis. Ann Intern Med 146(3):193–203

    Article  PubMed  Google Scholar 

  20. Kreymann KG, de Heer G, Nierhaus A, Kluge S (2007) Use of polyclonal immunoglobulins as adjunctive therapy for sepsis or septic shock. Crit Care Med 35:2677–2685

    Article  PubMed  CAS  Google Scholar 

  21. Laupland KB, Kirkpatrick AW, Delaney A (2007) Polyclonal intravenous immunoglobulin for the treatment of severe sepsis and septic shock in critically ill adults: a systematic review and meta-analysis. Crit Care Med 35(12):2686–2692

    Article  PubMed  CAS  Google Scholar 

  22. Alejandria MM, Lansang MA, Dans LF, Mantaring JB. (2001) Intravenous immunoglobulin for treating sepsis and septic shock. Cochrane Database Syst. Rev. Online. (2):CD001090

    Google Scholar 

  23. Werdan K, Pilz G, Bujdoso O et al (2007) Score-based immunoglobulin G therapy of patients with sepsis: the SBITS study. Crit Care Med 35(12):2693–2701

    Article  PubMed  CAS  Google Scholar 

  24. Cavazzuti I, Rinaldi L, Donno L (2010) Early use of immunoglobulin in septic shock. Critical Care; 14 S1: S10 (30th International Symposium on Intensive Care and Emergency Medicine,9-12 Marzo 2010, Brussels, Belgio)

    Google Scholar 

  25. Cavazzuti I, Rinaldi L, Braccini S et al (2009). Effects of intravenous IgM-enriched immunoglobulins on muscle tissue microcirculation in septic shock: a preliminary report. Intensive Care Med. Intensive Care Med; 35 S1: S239

    Google Scholar 

  26. Molnàr Z, Nierhause A, Esen F (2013) Immunoglobulin in Sepsis: Which Patients will Benefit the Most?. Annual Update on Intensive Care and Medicine Editor JL Vincent, Springer-Verlag, Berlin, In, pp 145–152

    Google Scholar 

  27. Berlot G, Vassallo MC, Busetto N 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 27:167–171

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Massimo Girardis .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Italia

About this paper

Cite this paper

Girardis, M., Serafini, G., Cavazzuti, I. (2014). Immunoglobulin as Adjunctive Therapy in Sepsis. In: Gullo, A. (eds) Anaesthesia, Pharmacology, Intensive Care and Emergency A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-5516-2_15

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5516-2_15

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5515-5

  • Online ISBN: 978-88-470-5516-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics