Choi Young Un, Kim Jun Gi, Jang Ji Young, Go Tae Hwa, Kim Kwangmin, Bae Keum Seok, Shim Hongjin
Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Acute Crit Care. 2023 Feb;38(1):21-30. doi: 10.4266/acc.2022.01515. Epub 2023 Feb 27.
The use of intravenous immunoglobulin (IVIG) in sepsis patients from bowel perforation is still debatable. However, few studies have evaluated the effect of IVIG as an adjuvant therapy after source control. This study aimed to analyze the effect of IVIG in critically ill patients who underwent surgery due to secondary peritonitis.
In total, 646 medical records of surgical patients who were treated for secondary peritonitis were retrospectively analyzed. IVIG use, initial clinical data, and changes in Sequential Organ Failure Assessment (SOFA) score over the 7-day admission in the intensive care unit for sepsis check, base excess, and delta neutrophil index (DNI) were analyzed. Mortalities and periodic profiles were assessed. Propensity scoring matching as comparative analysis was performed in the IVIG group and non-IVIG group.
General characteristics were not different between the two groups. The survival curve did not show a significantly reduced mortality in the IVIG. Moreover, the IVIG group did not have a lower risk ratio for mortality than the non-IVIG group. However, when the DNI were compared during the first 7 days, the reduction rate in the IVIG group was statistically faster than in the non-IVIG group (P<0.01).
The use of IVIG was significantly associated with faster decrease in DNI which means faster reduction of inflammation. Since the immune system is rapidly activated, the additional use of IVIG after source control surgery in abdominal sepsis patients, especially those with immunocompromised patients can be considered. However, furthermore clinical studies are needed.
静脉注射免疫球蛋白（IVIG）在肠穿孔脓毒症患者中的应用仍存在争议。然而，很少有研究评估IVIG作为源头控制后辅助治疗的效果。本研究旨在分析IVIG在因继发性腹膜炎接受手术的重症患者中的作用。
回顾性分析了646例接受继发性腹膜炎治疗的手术患者的病历。分析了IVIG的使用情况、初始临床数据以及在重症监护病房（ICU）住院7天期间序贯器官衰竭评估（SOFA）评分的变化、脓毒症检查的碱剩余和δ中性粒细胞指数（DNI）。评估了死亡率和周期性特征。在IVIG组和非IVIG组中进行倾向评分匹配作为比较分析。
两组的一般特征无差异。生存曲线未显示IVIG组死亡率显著降低。此外，IVIG组的死亡风险比并不低于非IVIG组。然而，在前7天比较DNI时，IVIG组的下降率在统计学上比非IVIG组更快（P<0.01）。
IVIG的使用与DNI更快下降显著相关，这意味着炎症更快减轻。由于免疫系统被迅速激活，对于腹部脓毒症患者，尤其是免疫功能低下的患者，在源头控制手术后额外使用IVIG是可以考虑的。然而，还需要进一步的临床研究。
