Dietz S, Lautenschläger C, Müller-Werdan U, Pilz G, Fraunberger P, Päsler M, Ebelt H, Walli A K, Werdan K, Nuding S
Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, St. Marien-Krankenhaus Siegen gem. GmbH, Kampenstraße 51, 57072, Siegen, Germany.
Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
Med Klin Intensivmed Notfmed. 2017 Jun;112(5):462-470. doi: 10.1007/s00063-016-0220-6. Epub 2016 Sep 27.
The role of intravenous immune globulin (Ig) therapy in patients with severe sepsis and septic shock is discussed controversially. Low initial IgG levels could help to identify those patients who might benefit from an adjunctive Ig treatment.
To investigate the effect of initial serum IgG levels on 28-day mortality in patients with severe sepsis and septic shock.
In this retrospective analysis of the SBITS trial data, 543 patients were allocated to four groups (quartiles) depending on their initial serum IgG levels (1: IgG ≤ 6.1 g/l; 2: IgG 6.2-8.4 g/l; 3: IgG 8.5-11.9 g/l; 4: IgG > 11.9 g/l). The third quartile was taken as the reference quartile. For the applied logistic regression model clinically relevant confounders were defined and integrated into further risk-adjusted calculations.
Patients with the lowest IgG levels had a mortality rate similar to those patients with initial IgG levels in the second and third quartile, representing the physiological IgG range in healthy people. Surprisingly, patients with the highest IgG levels even showed a significantly higher mortality in a risk-adjusted calculation compared to the reference quartile (OR 1.69, CI 1.01-2.81, p = 0.05). Subgroup analyses revealed that initial IgG levels were of no prognostic value in patients presenting with vasopressor-dependent septic shock on admission as well as in patients with either gram-positive or gram-negative sepsis.
Initially low IgG levels do not discriminate between survival and nonsurvival in patients with severe sepsis and septic shock. Therefore, low IgG cannot help to identify those patients who might benefit from an adjunctive IgG sepsis therapy. Whether a high initial IgG serum level is an independent mortality risk factor needs to be investigated prospectively.
静脉注射免疫球蛋白（Ig）治疗在严重脓毒症和脓毒性休克患者中的作用存在争议。初始IgG水平较低可能有助于识别那些可能从辅助性Ig治疗中获益的患者。
研究初始血清IgG水平对严重脓毒症和脓毒性休克患者28天死亡率的影响。
在对SBITS试验数据的这项回顾性分析中，543例患者根据其初始血清IgG水平被分为四组（四分位数）（1组：IgG≤6.1g/L；2组：IgG 6.2 - 8.4g/L；3组：IgG 8.5 - 11.9g/L；4组：IgG>11.9g/L）。第三四分位数被用作参考四分位数。对于所应用的逻辑回归模型，定义了临床相关混杂因素并将其纳入进一步的风险调整计算中。
IgG水平最低的患者死亡率与初始IgG水平处于第二和第三四分位数的患者相似，第二和第三四分位数代表健康人的生理IgG范围。令人惊讶的是，在风险调整计算中，IgG水平最高的患者与参考四分位数相比，死亡率显著更高（OR 1.69，CI 1.01 - 2.81，p = 0.05）。亚组分析显示，初始IgG水平对入院时依赖血管升压药的脓毒性休克患者以及革兰氏阳性或革兰氏阴性脓毒症患者均无预后价值。
在严重脓毒症和脓毒性休克患者中，初始IgG水平较低并不能区分生存者和非生存者。因此，低IgG水平无助于识别那些可能从辅助性Ig治疗脓毒症中获益的患者。初始IgG血清水平较高是否为独立的死亡风险因素需要前瞻性研究。
