Takano Hayabusa, Kanda Naoki, Wakimoto Yuji, Ohbe Hiroyuki, Nakamura Kensuke
Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan.
Department of Critical Care and Emergency Medicine, Showa General Hospital, Tokyo, Japan.
Front Immunol. 2025 Jan 16;15:1511481. doi: 10.3389/fimmu.2024.1511481. eCollection 2024.
Sepsis is a life-threatening condition caused by severe infection. The efficacy of intravenous immunoglobulin (IVIG) as adjunctive therapy on mortality remains controversial. Moreover, IVIG may favorably affect sepsis-induced immunosuppression like persistent inflammation, immunosuppression, and catabolism syndrome (PICS).
This study was a retrospective cohort study using inpatient claims database provided by Medical Data Vision, which included approximately 190,000 episodes of intensive care unit admissions in Japanese acute care hospitals between April 2008 and September 2021. We used a propensity score-matched analysis to compare outcomes between the IVIG and control groups. Primary outcomes were 28-day mortality, while secondary outcomes included in-hospital mortality, the Barthel Index at discharge, length of hospital stay and laboratory data (albumin, C-reactive protein (CRP), and lymphocyte count) on days 14 and 28.
Of the 17,626 patients enrolled, 15,159 (786 in the IVIG group and 14,373 in the control group) were included in the analysis. Propensity score matching generated 758 matched pairs. Before matching, 28-day mortality and in-hospital mortality were lower in the control group; however, in the matched cohort, 28-day mortality was significantly lower in the IVIG group than in the control group (90/758 [11.9%] vs 124/758 [16.4%]; risk difference [95% confidence intervals (CI)], -4.5% [-8.0% to -1.0%]; P = 0.015). In-hospital mortality in the matched cohort was also significantly more favorable in the IVIG group (137/758 [18.1%] vs 177/758 [23.4%]; risk difference [95%CI], -5.3% [-9.3% to -1.2%]; P = 0.013). Favorable outcomes in terms of albumin on days14 and 28 and CRP levels on day 28 were observed in the IVIG group.
The administration of IVIG was associated with a reduction in sepsis mortality and favorable outcomes in laboratory parameters and the functional status. These results will contribute to the ongoing debate on the efficacy of IVIG for sepsis. The results obtained herein suggest the benefit of IVIG, particularly in mitigating PICS. Further research, including prospective studies, is warranted to confirm these results and examine long-term outcomes.
脓毒症是一种由严重感染引起的危及生命的病症。静脉注射免疫球蛋白（IVIG）作为辅助治疗对死亡率的疗效仍存在争议。此外，IVIG可能对脓毒症诱导的免疫抑制，如持续性炎症、免疫抑制和分解代谢综合征（PICS）产生有利影响。
本研究是一项回顾性队列研究，使用了Medical Data Vision提供的住院患者索赔数据库，其中包括2008年4月至2021年9月期间日本急性护理医院约19万例重症监护病房入院病例。我们使用倾向评分匹配分析来比较IVIG组和对照组的结果。主要结局是28天死亡率，次要结局包括住院死亡率、出院时的巴氏指数、住院时间以及第14天和第28天的实验室数据（白蛋白、C反应蛋白（CRP）和淋巴细胞计数）。
在纳入的17626例患者中，15159例（IVIG组786例，对照组14373例）纳入分析。倾向评分匹配产生了758对匹配病例。匹配前，对照组的28天死亡率和住院死亡率较低；然而，在匹配队列中，IVIG组的28天死亡率显著低于对照组（90/758 [11.9%] 对124/758 [16.4%]；风险差异 [95%置信区间（CI）]，-4.5% [-8.0%至-1.0%]；P = 0.015）。匹配队列中的住院死亡率在IVIG组也明显更有利（137/758 [18.1%] 对177/758 [23.4%]；风险差异 [95%CI]，-5.3% [-9.3%至-1.2%]；P = 0.013）。IVIG组在第14天和第28天的白蛋白以及第28天的CRP水平方面观察到有利结果。
IVIG的使用与脓毒症死亡率降低以及实验室参数和功能状态的有利结果相关。这些结果将有助于正在进行的关于IVIG治疗脓毒症疗效的辩论。本文获得的结果表明IVIG的益处，特别是在减轻PICS方面。有必要进行进一步的研究，包括前瞻性研究，以证实这些结果并检查长期结局。
