The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure
Martin-Loeches, Ignacio (James's University Hospitals Dublin)
Muriel-Bombín, Arturo (Hospital Universitario Río Hortega (Valladolid))
Ferrer, Ricard (Hospital Universitari Vall d'Hebron)
Artigas Raventós, Antoni (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Sole-Violan, Jordi (Hospital Universitario de Gran Canaria Dr. Negrín)
Lorente, Leonardo (Hospital Universitario de Canarias (La Laguna))
Andaluz-Ojeda, David (Hospital Clínico Universitario de Valladolid)
Prina-Mello, Adriele (James's St (Irlanda))
Herrán-Monge, Ruben (Hospital Universitario Río Hortega (Valladolid))
Suberviola, Borja (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Rodriguez-Fernandez, Ana (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Merino, Pedro (Hospital Universitario Río Hortega (Valladolid))
Loza, Ana M. (Hospital Universitario Virgen de Valme (Sevilla, Andalusia))
Garcia-Olivares, Pablo (Hospital General Universitario Gregorio Marañón)
Anton, Eduardo (Critical Care Medicine Service, Hospital de Manacor)
Tamayo, Eduardo (Hospital Clínico Universitario de Valladolid)
Trapiello, Wysali (Hospital Clínico Universitario de Valladolid)
Blanco, Jesús (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Bermejo-Martin, Jesús F.. (Hospital Clínico Universitario de Valladolid)
Universitat Autònoma de Barcelona

Fecha:	2017
Resumen:	Pre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity. This was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score at ICU admission (SOFA < 8, n = 122 and SOFA ≥ 8, n = 156), and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by Kaplan-Meier and multivariate logistic regression analysis. ICU/hospital mortality in the SOFA < 8 group was 14. 8/23. 0%, compared to 30. 1/35. 3% in the SOFA ≥ 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG < 407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated with a reduction in the survival mean time of 6. 6 days in the first 28 days and was a robust predictor of mortality risk either during the acute or during the post-acute phase of the disease (OR for ICU mortality: 13. 79; OR for hospital mortality: 7. 98). This predictive ability remained in the absence of prior immunosuppression (OR for ICU mortality: 17. 53; OR for hospital mortality: 5. 63). Total IgG < 407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA ≥ 8 group, we found no immunoglobulin thresholds associated with neither ICU nor hospital mortality. Endogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortalities. The online version of this article (doi:10. 1186/s13613-017-0268-3) contains supplementary material, which is available to authorized users.
Ayudas:	Instituto de Salud Carlos III EMER 07/050 Instituto de Salud Carlos III PI12-01815
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan aquestes es distribueixin sota la mateixa llicència que regula l'obra original i es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Immunoglobulins ; Sepsis ; Severity ; Survival
Publicado en:	Annals of Intensive Care, Vol. 7 (april 2017) , ISSN 2110-5820

DOI: 10.1186/s13613-017-0268-3
PMID: 28429310

9 p, 991.4 KB

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