RT Journal Article
SR Electronic
T1 The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure
JF bioRxiv
FD Cold Spring Harbor Laboratory
SP 116665
DO 10.1101/116665
A1 Ignacio Martin-Loeches
A1 Arturo Muriel-Bombín
A1 Ricard Ferrer
A1 Antonio Artigas
A1 Jordi Sole-Violan
A1 Leonardo Lorente
A1 David Andaluz-Ojeda
A1 Adriele Prina-Mello
A1 Ruben Herrán-Monge
A1 Borja Suberviola
A1 Ana Rodriguez-Fernandez
A1 Pedro Merino
A1 Ana M Loza
A1 Pablo Garcia-Olivares
A1 Eduardo Anton
A1 Eduardo Tamayo
A1 Wysali Trapiello
A1 Jesús Blanco
A1 Jesús F Bermejo-Martin
A1 GRECIA Group
YR 2017
UL http://biorxiv.org/content/early/2017/03/14/116665.abstract
AB Background 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.Methods 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 al 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.Results 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 to 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 and 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 immunosupression (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 to neither ICU nor to hospital mortality.Conclusions 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 mortality.ABISS-EdusepsisAntiBiotic Intervention in Severe SepsisAPACHE-IIAcute Physiology and Chronic Health Evaluation II scoreGRECIAGrupo de Estudios y Análisis en Cuidados Intensivos.IVIGintravenous immunoglobulinISC IgGAMimmunoscore combining IgG, IgA, IgMISC IgGMimmunoscore combining IgG, IgMISC IgGAimmunoscore combining IgG, IgAISC IgMAimmunoscore combining IgM, IgA.SBITsScore-based immunoglobulin G therapy of patients with sepsisSOFASequential Organ Failure Assessment score