Jorge-Ignacio Martinez1, Hector-Fabio Sánchez2, Julio-Alberto Velandia3, Zulma Urbina4, María-Cristina Florián5, Mauricio-Antonio Martínez6, Evangelos J Giamarellos-Bourboulis7, Carmen-Juliana Pino-Pinzón8, Guillermo Ortiz9, Edgar Celis10. 1. Medical Director Critical Medicine and Intensive Care Service, San Pedro Hospital Foundation, Pasto, Nariño, Colombia. 2. Medical Director Intensive Care Unit, Departmental University Hospital of Nariño, Pasto, Nariño, Colombia. 3. Medical Director of the Intensive Care Unit, San Rafael Tunja University Hospital, Tunja, Boyacá, Colombia. 4. Medical Director Intensive Care Unit, Erasmo Meoz University Hospital, Cúcuta, Norte de Santander, Colombia. 5. Medical Director Intensive Care Unit, Departmental Hospital Santa Sofía Caldas, Coordinator Medicine and Intensive Care Program Manizales University, Manizales, Caldas, Colombia. 6. Medical Director Critical Medicine and Intensive Care Service Serviclínicos Dromédica Clinic, Bucaramanga, Santander, Colombia. 7. Professor of Internal Medicine Director, Master (MSc) Program of Infectious Diseases, 4th Department of Internal Medicine, ATTIKON University Hospital, Athens, Greece. 8. Clinical Pharmacology Professor El Bosque University, Bogota, Colombia. Electronic address: cpinop@unbosque.edu.co. 9. Internal Medicine, Pneumology and Critical Care Postgraduate Director, El Bosque University, Bogotá, Colombia. 10. Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Abstract
The therapeutic potential of IgM-enriched immunoglobulin preparations (IgGAM) in sepsis remains a field of debate. The use of polyclonal immunoglobulins as adjuvant therapy (Esen & Tugrul, 2009; Kaukonen et al., 2014; Molnár et al., 2013; Taccone et al., 2009) has been shown to improve clinical outcomes in terms of mortality. This study analyze the impact of IgM-enriched IgG (IgGM) as additional immunomodulation. Patients and methods: This is a retrospective registry of 1196 patients with severe sepsis and septic shock from nine Intensive Care Units in Colombia, from routine clinical practice; 220 patients treated with IgGAM were registered. Fully matched comparators for severity and type of infection selected among patients non-treated with IgGAM. Mortality after 28 days was 30.5% among IgGAM-treated patients and 40.5% among matched comparators. Results: Multivariate Cox regression analysis showed IgGAM treatment to be the only variable protective from death after 28 days (hazard ratio 0.62; 0.45-0.86; p: 0.004). Results reinforce the importance of IgGAM treatment for favorable outcome after septic shock and are in line with recent published meta-analyses. This study showed that treatment with IgGM in patients with sepsis was an independent modulator of the 28-day associated with a lower mortality.
The therapeutic potential of IgM-enriched immunoglobulin preparations (IgGAM) in sepsis remains a field of debate. The use of polyclonal immunoglobulins as adjuvant therapy (Esen & Tugrul, 2009; Kaukonen et al., 2014; Molnár et al., 2013; Taccone et al., 2009) has been shown to improve clinical outcomes in terms of mortality. This study analyze the impact of IgM-enriched IgG (IgGM) as additional immunomodulation. Patients and methods: This is a retrospective registry of 1196 patients with severe sepsis and septic shock from nine Intensive Care Units in Colombia, from routine clinical practice; 220 patients treated with IgGAM were registered. Fully matched comparators for severity and type of infection selected among patients non-treated with IgGAM. Mortality after 28 days was 30.5% among IgGAM-treated patients and 40.5% among matched comparators. Results: Multivariate Cox regression analysis showed IgGAM treatment to be the only variable protective from death after 28 days (hazard ratio 0.62; 0.45-0.86; p: 0.004). Results reinforce the importance of IgGAM treatment for favorable outcome after septic shock and are in line with recent published meta-analyses. This study showed that treatment with IgGM in patients with sepsis was an independent modulator of the 28-day associated with a lower mortality.