The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure
Abstract 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 e...
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SpringerOpen
2017-04-01
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Series: | Annals of Intensive Care |
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Online Access: | http://link.springer.com/article/10.1186/s13613-017-0268-3 |
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language |
English |
format |
Article |
sources |
DOAJ |
author |
Ignacio Martin-Loeches Arturo Muriel-Bombín Ricard Ferrer Antonio Artigas Jordi Sole-Violan Leonardo Lorente David Andaluz-Ojeda Adriele Prina-Mello Ruben Herrán-Monge Borja Suberviola Ana Rodriguez-Fernandez Pedro Merino Ana M. Loza Pablo Garcia-Olivares Eduardo Anton Eduardo Tamayo Wysali Trapiello Jesús Blanco Jesús F. Bermejo-Martin the GRECIA group |
spellingShingle |
Ignacio Martin-Loeches Arturo Muriel-Bombín Ricard Ferrer Antonio Artigas Jordi Sole-Violan Leonardo Lorente David Andaluz-Ojeda Adriele Prina-Mello Ruben Herrán-Monge Borja Suberviola Ana Rodriguez-Fernandez Pedro Merino Ana M. Loza Pablo Garcia-Olivares Eduardo Anton Eduardo Tamayo Wysali Trapiello Jesús Blanco Jesús F. Bermejo-Martin the GRECIA group The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure Annals of Intensive Care Immunoglobulins Sepsis Severity Survival |
author_facet |
Ignacio Martin-Loeches Arturo Muriel-Bombín Ricard Ferrer Antonio Artigas Jordi Sole-Violan Leonardo Lorente David Andaluz-Ojeda Adriele Prina-Mello Ruben Herrán-Monge Borja Suberviola Ana Rodriguez-Fernandez Pedro Merino Ana M. Loza Pablo Garcia-Olivares Eduardo Anton Eduardo Tamayo Wysali Trapiello Jesús Blanco Jesús F. Bermejo-Martin the GRECIA group |
author_sort |
Ignacio Martin-Loeches |
title |
The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure |
title_short |
The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure |
title_full |
The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure |
title_fullStr |
The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure |
title_full_unstemmed |
The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure |
title_sort |
protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure |
publisher |
SpringerOpen |
series |
Annals of Intensive Care |
issn |
2110-5820 |
publishDate |
2017-04-01 |
description |
Abstract 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 at 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 with 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 or during 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 immunosuppression (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 with neither ICU nor 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 mortalities. |
topic |
Immunoglobulins Sepsis Severity Survival |
url |
http://link.springer.com/article/10.1186/s13613-017-0268-3 |
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doaj-7b9981b65b134b9bab2dadaf47a6685b2020-11-24T23:24:02ZengSpringerOpenAnnals of Intensive Care2110-58202017-04-01711910.1186/s13613-017-0268-3The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failureIgnacio Martin-Loeches0Arturo Muriel-Bombín1Ricard Ferrer2Antonio Artigas3Jordi Sole-Violan4Leonardo Lorente5David Andaluz-Ojeda6Adriele Prina-Mello7Ruben Herrán-Monge8Borja Suberviola9Ana Rodriguez-Fernandez10Pedro Merino11Ana M. Loza12Pablo Garcia-Olivares13Eduardo Anton14Eduardo Tamayo15Wysali Trapiello16Jesús Blanco17Jesús F. Bermejo-Martin18the GRECIA group19Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s University Hospitals DublinIntensive Care Department, Hospital Universitario Río Hortega de ValladolidIntensive Care Department, Vall d’Hebron University Hospital, Shock Organ Dysfunction and Resuscitation Research Group, Vall d’ Hebron Research InstituteABISS-Edusepsis (AntiBiotic Intervention in Severe Sepsis), Intensive Care Department, Vall d’Hebron University HospitalABISS-Edusepsis (AntiBiotic Intervention in Severe Sepsis), Intensive Care Department, Vall d’Hebron University HospitalABISS-Edusepsis (AntiBiotic Intervention in Severe Sepsis), Intensive Care Department, Vall d’Hebron University HospitalCritical Care Medicine Service, Hospital Clínico Universitario de ValladolidLaboratory for Biological Characterisation of Advanced Materials, Trinity Translational Medicine Institute (TTMI)Intensive Care Department, Hospital Universitario Río Hortega de ValladolidABISS-Edusepsis (AntiBiotic Intervention in Severe Sepsis), Intensive Care Department, Vall d’Hebron University HospitalMicrobiology Service, Hospital Marques de ValdecillaIntensive Care Department, Hospital Universitario Río Hortega de ValladolidABISS-Edusepsis (AntiBiotic Intervention in Severe Sepsis), Intensive Care Department, Vall d’Hebron University HospitalABISS-Edusepsis (AntiBiotic Intervention in Severe Sepsis), Intensive Care Department, Vall d’Hebron University HospitalABISS-Edusepsis (AntiBiotic Intervention in Severe Sepsis), Intensive Care Department, Vall d’Hebron University HospitalAnesthesiology Service, Hospital Clínico Universitario de ValladolidBIO∙SEPSIS (Laboratory of Biomedical Research in Sepsis), Hospital Clínico Universitario, SACYLIntensive Care Department, Hospital Universitario Río Hortega de ValladolidBIO∙SEPSIS (Laboratory of Biomedical Research in Sepsis), Hospital Clínico Universitario, SACYLGRECIA Group (Grupo de Estudios y Análisis en Cuidados Intensivos), Critical Care Medicine Service, Hospital Universitario Río Hortega de ValladolidAbstract 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 at 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 with 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 or during 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 immunosuppression (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 with neither ICU nor 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 mortalities.http://link.springer.com/article/10.1186/s13613-017-0268-3ImmunoglobulinsSepsisSeveritySurvival |