使用五聚体免疫球蛋白IgM似乎并不能改善腹部大手术后的脓毒症结局：一项单中心回顾性分析。
Sepsis Outcome after Major Abdominal Surgery Does Not Seem to Be Improved by the Use of Pentameric Immunoglobulin IgM: A Single-Center Retrospective Analysis.
作者信息
Perrella Alessandro, Rinaldi Luca, Guarino Ilaria, Bernardi Francesca Futura, Castriconi Maurizio, Antropoli Carmine, Pafundi Pia Clara, Di Micco Pierpaolo, Sarno Marina, Capoluongo Nicolina, Minei Giuseppina, Perrella Marco, Frangiosa Antonio, Capuano Annalisa
机构信息
Department of Emerging Infectious Disease at High Countagiousness, AORN Ospedali dei Colli, P.O.D. Cotugno, 80131 Naples, Italy.
Department of Medicine and Health Sciences, "Vincenzo Tiberio" Università degli Studi del Molise, 86000 Campobasso, Italy.
出版信息
J Clin Med. 2023 Oct 31;12(21):6887. doi: 10.3390/jcm12216887.
BACKGROUND
Sepsis still represents a major public health issue worldwide, and the immune system plays a main role during infections; therefore, its activity is mandatory to resolve this clinical condition. In this report, we aimed to retrospectively verify in a real-life setting the possible usefulness of pentameric IgM plus antibiotics in recovering patients with sepsis after major abdominal surgery.
MATERIALS/METHODS: We reviewed, from January 2013 until December 2019, all adult patients admitted to the ICU for sepsis or septic shock (2) after major abdominal surgery. Among these patients, were identified those that, according to legal indication and licenses in Italy, were treated with pentameric IgM plus antibiotics (Group A) or with antibiotics alone (Group B). The following parameters were evaluated: blood gas analysis, lactate, CRP, procalcitonin, endotoxin activity, liver and renal function, coagulation and blood cell count at different time points (every 48 h for at least 7 days). Differences between groups were analyzed using Fisher's exact test or a chi-square test for categorical variables. A Mann-Whitney U test or Kruskal-Wallis test were instead been performed to compare continuous variables. Univariate and multivariate analysis were also performed.
RESULTS
Over a period of 30 months, 24 patients were enrolled in Group A and 20 patients in Group B. In those subjects, no statistical differences were found in terms of bacterial or fungal infection isolates, when detected in a blood culture test, or according to inflammatory index, a score, lactate levels and mortality rate. A 48 h response was statistically more frequent in Group B than in Group A, while no differences were found in other clinical and laboratory evaluations.
CONCLUSIONS
Based on our results, the use of pentameric IgM does not seem to give any clinical advantages in preventing sepsis after major abdominal surgery.
背景
脓毒症仍是全球主要的公共卫生问题，免疫系统在感染过程中起主要作用；因此，其活性对于解决这种临床状况至关重要。在本报告中，我们旨在在实际临床环境中进行回顾性验证，五聚体IgM联合抗生素对腹部大手术后脓毒症患者康复的可能作用。
材料/方法：我们回顾了2013年1月至2019年12月期间因腹部大手术后发生脓毒症或脓毒性休克而入住重症监护病房（ICU）的所有成年患者。在这些患者中，根据意大利的合法适应症和许可，确定那些接受五聚体IgM联合抗生素治疗的患者（A组）或仅接受抗生素治疗的患者（B组）。评估以下参数：不同时间点（至少7天内每48小时一次）的血气分析、乳酸、CRP、降钙素原、内毒素活性、肝肾功能、凝血和血细胞计数。分类变量采用Fisher精确检验或卡方检验分析组间差异。连续变量则采用Mann-Whitney U检验或Kruskal-Wallis检验进行比较。还进行了单因素和多因素分析。
结果
在30个月的时间里，A组纳入24例患者，B组纳入20例患者。在这些受试者中，血液培养检测中检测到的细菌或真菌感染分离株、炎症指标、评分、乳酸水平和死亡率方面均未发现统计学差异。B组48小时的反应在统计学上比A组更频繁，而在其他临床和实验室评估中未发现差异。
结论
根据我们的结果，使用五聚体IgM在预防腹部大手术后脓毒症方面似乎没有任何临床优势。
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