Martin-Loeches Ignacio, Muriel-Bombín Arturo, Ferrer Ricard, Artigas Antonio, Sole-Violan Jordi, Lorente Leonardo, Andaluz-Ojeda David, Prina-Mello Adriele, Herrán-Monge Ruben, Suberviola Borja, Rodriguez-Fernandez Ana, Merino Pedro, Loza Ana M, Garcia-Olivares Pablo, Anton Eduardo, Tamayo Eduardo, Trapiello Wysali, Blanco Jesús, Bermejo-Martin Jesús F
Multidisciplinary Intensive Care Research Organization (MICRO), St. James's University Hospitals Dublin, James's St, Ushers, Dublin 8, Ireland.
Intensive Care Department, Hospital Universitario Río Hortega de Valladolid, Calle Dulzaina, 2, 47012, Valladolid, Spain.
Ann Intensive Care. 2017 Dec;7(1):44. doi: 10.1186/s13613-017-0268-3. Epub 2017 Apr 20.
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.
对内源性免疫球蛋白水平进行预评估是改善静脉注射免疫球蛋白治疗脓毒症效果的一种潜在策略，但仍需开展更多工作以确定哪些患者能从该治疗中获益最大。本研究的目的是根据疾病严重程度评估内源性免疫球蛋白对脓毒症患者死亡风险的影响。
这是一项回顾性观察性研究，纳入了278例因脓毒症入住重症监护病房（ICU）且符合SEPSIS-3标准的患者，这些患者来自西班牙的GRECIA和ABISS-EDUSEPSIS队列。根据患者入住ICU时的序贯器官衰竭评估（SOFA）评分将其分为两组（SOFA＜8，n = 122；SOFA≥8，n = 156），并通过Kaplan-Meier法和多因素逻辑回归分析研究每组患者入住ICU时免疫球蛋白水平与死亡率之间的关联。
SOFA＜8组的ICU/医院死亡率分别为14.8%/23.0%，而SOFA≥8组为30.
