社区获得性肺炎重症患者免疫球蛋白反应及疾病进展的纵向评估

Longitudinal assessment of immunoglobulin response and disease progression in critically ill patients with community acquired pneumonia.

作者信息

Rademaker Emma, Vernooij Lisette M, van der Poll Tom, Bonten Marc J M, Leavis Helen, Cremer Olaf L, Derde Lennie P G

机构信息

Julius Center for Health Sciences and Primary Care, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.

Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands.

出版信息

Crit Care. 2024 Dec 5;28(1):405. doi: 10.1186/s13054-024-05197-3.

DOI:10.1186/s13054-024-05197-3

PMID:39639324

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11622494/

Abstract

BACKGROUND

Low endogenous immunoglobulin(Ig)-levels are common in critically ill patients with sepsis, but it is unknown whether low Ig-levels are associated with poor outcome, and in which patients Ig-replacement therapy (IgRT) improves outcome. Given the crucial role of immunoglobulins in eliminating certain encapsulated pathogens, we examined the relationship between serial Ig-levels and disease course in critically ill patients with community acquired pneumonia (sCAP) caused by encapsulated or other pathogens.

METHODS

We included a cohort of consecutive critically ill patients with CAP, and PaO/FiO-ratio < 200 with or without septic shock, from an existing biorepository where microbiological causes of infection had been adjudicated in a protocolized manner. We used generalized linear mixed models to assess the association between IgG and IgM (measured on admission days 1, 3 and 7) and disease course (Sequential Organ Failure Assessment (SOFA)-score on day 2, 4, and 8) for all-cause sCAP and for episodes caused by Streptococcus (S.) pneumoniae or Haemophilus (H.) influenzae.

RESULTS

We included 255 eligible patients admitted with CAP, of which 82 (32%) episodes were caused by S. pneumoniae or H. influenzae. 151 (59%) patients had low IgG (< 7.0 g/L), 77 (30%) had low IgM (< 0.4 g/L), and 56 (22%) had both. A lower IgG-level was related to a slightly higher SOFA-score at admission (β = - 0.07 per 1 g/L IgG, p = 0.029), but an IgG-level decline over time was not associated with a SOFA-score increase (β = - 0.04, p = 0.564). IgM-levels were not associated with changes in SOFA-score over time. Neither association was affected by the presence or absence of S. pneumoniae and H. influenzae.

CONCLUSION

In critically ill patients with CAP, IgG and IgM dynamics in the first week of ICU stay are not associated with clinically relevant changes in disease course, regardless of the causative pathogen.

摘要

背景

内源性免疫球蛋白（Ig）水平低在脓毒症重症患者中很常见，但尚不清楚低Ig水平是否与不良预后相关，以及Ig替代疗法（IgRT）能改善哪些患者的预后。鉴于免疫球蛋白在清除某些包膜病原体方面的关键作用，我们研究了重症社区获得性肺炎（sCAP）患者（由包膜或其他病原体引起）系列Ig水平与病程之间的关系。

方法

我们纳入了一组连续的重症CAP患者，这些患者伴有或不伴有感染性休克，且PaO/FiO比值<200，数据来自一个现有的生物样本库，其中感染的微生物病因已按照标准化方案进行判定。我们使用广义线性混合模型评估IgG和IgM（在入院第1、3和7天测量）与全因sCAP以及由肺炎链球菌（S.）或流感嗜血杆菌（H.）引起的发作的病程（第2、4和8天的序贯器官衰竭评估（SOFA）评分）之间的关联。

结果

我们纳入了255例符合条件的CAP入院患者，其中82例（32%）发作由肺炎链球菌或流感嗜血杆菌引起。151例（59%）患者IgG水平低（<7.0 g/L），77例（30%）患者IgM水平低（<0.4 g/L），56例（22%）患者两者均低。较低的IgG水平与入院时略高的SOFA评分相关（每1 g/L IgG的β=-0.07，p=0.029），但IgG水平随时间下降与SOFA评分增加无关（β=-0.04，p=0.564）。IgM水平与SOFA评分随时间的变化无关。无论是否存在肺炎链球菌和流感嗜血杆菌两者之间的关联均不受影响。