Higher levels of IgA and IgG at sepsis onset are associated with higher mortality: results from the Albumin Italian Outcome Sepsis (ALBIOS) trial

Annals of Intensive Care

Pietro Caironi¹  Irene Principale¹  Roberto Latini²  Francesca Motta²  Jennifer M. T. A. Meessen²  Nicolò M. Agnelli²  Giacomo Bellani³  Daniela Albiero³  Stefano Romagnoli⁴  Alessandra Bandera⁵  Laura Alagna⁵  Barbara Bottazzi⁶  Fabio S. Taccone⁷  Giacomo Grasselli⁸  Luigi Vivona⁸  Andrea Cortegiani⁹  Francesca Di Marzo Capozzi^1,10  Walter Taccone^1,10  Vieri Parrini^1,11  Roberto Keim^1,12 

[1] Department of Anesthesia and Critical Care, AOU S. Luigi Gonzaga;Department of Cardiovascular Medicine, Institute for Pharmacological Research Mario Negri IRCCS;Department of Emergency and Intensive Care, San Gerardo Hospital;Department of Health Science, Section of Anesthesia and Critical Care, University of Florence;Department of Infectious Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico;Department of Inflammation and Immunology, Humanitas Clinical and Research Centre – IRCCS;Department of Intensive Care, Université Libre de Bruxelles (ULB);Department of Pathophysiology and Transplantation, Università Degli Studi di Milano;Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo;Futura Diagnostica srl;SOS Anesthesia and Reanimation, Ospedale del Mugello, Usl Toscana Centro;UOC Anesthesia, Reanimation and Intensive Care;

关键词: IgA;    IgG;    IgM Immunoglobulins;    Mortality;    Septic shock;    Sepsis;   

DOI  :  10.1186/s13613-021-00952-z

来源: DOAJ

【 摘 要 】

Abstract Background The role of intravenous immunoglobulins (IVIG) during sepsis is controversial, as different trials on IVIG have observed inconsistent survival benefits. We aimed to elucidate the possible association and clinical significance between circulating levels of immunoglobulins. Methods In a subset of 956 patients with severe sepsis and septic shock of the multicentre, open-label RCT ALBIOS, venous blood samples were serially collected 1, 2, and 7 days after enrolment (or at ICU discharge, whichever came first). IgA, IgG and IgM concentrations were assayed in all patients on day 1 and in a subgroup of 150 patients on days 2 and 7. Ig concentrations were measured employing a turbidimetric assay, OSR61171 system. Results IgA on day 1 had a significant predictive value for both 28-day and 90-day mortality (28-day mortality, HR: 1.50 (95% CI 1.18–1.92); 90-day mortality, HR: 1.54 (95% CI 1.25–1.91)). IgG, but not IgM, on day 1 showed similar results for 28-day (HR 1.83 (95% CI 1.33–2.51) and 90-day mortality HR: 1.66 (95% CI 1.23–2.25)). In addition, lower levels of IgG but not of IgA and IgM, at day 1 were associated with significantly higher risk of secondary infections (533 [406–772] vs 600 [452–842] mg/dL, median [Q1–Q3], p = 0.007). Conclusions In the largest cohort study of patients with severe sepsis or septic shock, we found that high levels of IgA and IgG on the first day of diagnosis were associated with a decreased 90-day survival. No association was found between IgM levels and survival. As such, the assessment of endogenous immunoglobulins could be a useful tool to identify septic patients at high risk of mortality. Trial registration #NCT00707122, Clinicaltrial.gov, registered 30 June 2008

【 授权许可】

Unknown