Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shock
Abstract Background The administration of low-dose intravenous immunoglobulin G (IVIgG) (5 g/day for 3 days; approximate total 0.3 g/kg) is widely used as an adjunctive treatment for patients with sepsis in Japan, but its efficacy in the reduction of mortality has not been evaluated. We investigated...
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BMC
2017-07-01
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Series: | Critical Care |
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Online Access: | http://link.springer.com/article/10.1186/s13054-017-1764-4 |
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language |
English |
format |
Article |
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DOAJ |
author |
Yusuke Iizuka Masamitsu Sanui Yusuke Sasabuchi Alan Kawarai Lefor Mineji Hayakawa Shinjiro Saito Shigehiko Uchino Kazuma Yamakawa Daisuke Kudo Kohei Takimoto Toshihiko Mayumi Takeo Azuhata Fumihito Ito Shodai Yoshihiro Katsura Hayakawa Tsuyoshi Nakashima Takayuki Ogura Eiichiro Noda Yoshihiko Nakamura Ryosuke Sekine Yoshiaki Yoshikawa Motohiro Sekino Keiko Ueno Yuko Okuda Masayuki Watanabe Akihito Tampo Nobuyuki Saito Yuya Kitai Hiroki Takahashi Iwao Kobayashi Yutaka Kondo Wataru Matsunaga Sho Nachi Toru Miike Hiroshi Takahashi Shuhei Takauji Kensuke Umakoshi Takafumi Todaka Hiroshi Kodaira Kohkichi Andoh Takehiko Kasai Yoshiaki Iwashita Hideaki Arai Masato Murata Masahiro Yamane Kazuhiro Shiga Naoto Hori |
spellingShingle |
Yusuke Iizuka Masamitsu Sanui Yusuke Sasabuchi Alan Kawarai Lefor Mineji Hayakawa Shinjiro Saito Shigehiko Uchino Kazuma Yamakawa Daisuke Kudo Kohei Takimoto Toshihiko Mayumi Takeo Azuhata Fumihito Ito Shodai Yoshihiro Katsura Hayakawa Tsuyoshi Nakashima Takayuki Ogura Eiichiro Noda Yoshihiko Nakamura Ryosuke Sekine Yoshiaki Yoshikawa Motohiro Sekino Keiko Ueno Yuko Okuda Masayuki Watanabe Akihito Tampo Nobuyuki Saito Yuya Kitai Hiroki Takahashi Iwao Kobayashi Yutaka Kondo Wataru Matsunaga Sho Nachi Toru Miike Hiroshi Takahashi Shuhei Takauji Kensuke Umakoshi Takafumi Todaka Hiroshi Kodaira Kohkichi Andoh Takehiko Kasai Yoshiaki Iwashita Hideaki Arai Masato Murata Masahiro Yamane Kazuhiro Shiga Naoto Hori Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shock Critical Care Polyclonal intravenous immunoglobulin G IVIG Propensity score Sepsis Infection Adjunctive therapy |
author_facet |
Yusuke Iizuka Masamitsu Sanui Yusuke Sasabuchi Alan Kawarai Lefor Mineji Hayakawa Shinjiro Saito Shigehiko Uchino Kazuma Yamakawa Daisuke Kudo Kohei Takimoto Toshihiko Mayumi Takeo Azuhata Fumihito Ito Shodai Yoshihiro Katsura Hayakawa Tsuyoshi Nakashima Takayuki Ogura Eiichiro Noda Yoshihiko Nakamura Ryosuke Sekine Yoshiaki Yoshikawa Motohiro Sekino Keiko Ueno Yuko Okuda Masayuki Watanabe Akihito Tampo Nobuyuki Saito Yuya Kitai Hiroki Takahashi Iwao Kobayashi Yutaka Kondo Wataru Matsunaga Sho Nachi Toru Miike Hiroshi Takahashi Shuhei Takauji Kensuke Umakoshi Takafumi Todaka Hiroshi Kodaira Kohkichi Andoh Takehiko Kasai Yoshiaki Iwashita Hideaki Arai Masato Murata Masahiro Yamane Kazuhiro Shiga Naoto Hori |
author_sort |
Yusuke Iizuka |
title |
Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shock |
title_short |
Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shock |
title_full |
Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shock |
title_fullStr |
Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shock |
title_full_unstemmed |
Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shock |
title_sort |
low-dose immunoglobulin g is not associated with mortality in patients with sepsis and septic shock |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2017-07-01 |
description |
Abstract Background The administration of low-dose intravenous immunoglobulin G (IVIgG) (5 g/day for 3 days; approximate total 0.3 g/kg) is widely used as an adjunctive treatment for patients with sepsis in Japan, but its efficacy in the reduction of mortality has not been evaluated. We investigated whether the administration of low-dose IVIgG is associated with clinically important outcomes including intensive care unit (ICU) and in-hospital mortality. Methods This is a post-hoc subgroup analysis of data from a retrospective cohort study, the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study. The JSEPTIC DIC study was conducted in 42 ICUs in 40 institutions throughout Japan, and it investigated associations between sepsis-related coagulopathy, anticoagulation therapies, and clinical outcomes of 3195 adult patients with sepsis and septic shock admitted to ICUs from January 2011 through December 2013. To investigate associations between low-dose IVIgG administration and mortalities, propensity score-based matching analysis was used. Results IVIgG was administered to 960 patients (30.8%). Patients who received IVIgG were more severely ill than those who did not (Acute Physiology and Chronic Health Evaluation (APACHE) II score 24.2 ± 8.8 vs 22.6 ± 8.7, p < 0.001). They had higher ICU mortality (22.8% vs 17.4%, p < 0.001), but similar in-hospital mortality (34.4% vs 31.0%, p = 0.066). In propensity score-matched analysis, 653 pairs were created. Both ICU mortality and in-hospital mortality were similar between the two groups (21.0% vs 18.1%, p = 0.185, and 32.9% vs 28.6%, p = 0.093, respectively) using generalized estimating equations fitted with logistic regression models adjusted for other therapeutic interventions. The administration of IVIgG was not associated with ICU or in-hospital mortality (odds ratio (OR) 0.883; 95% confidence interval (CI) 0.655–1.192, p = 0.417, and OR 0.957, 95% CI, 0.724–1.265, p = 0.758, respectively). Conclusions In this analysis of a large cohort of patients with sepsis and septic shock, the administration of low-dose IVIgG as an adjunctive therapy was not associated with a decrease in ICU or in-hospital mortality. Trial registration University Hospital Medical Information Network Individual Clinical Trials Registry, UMIN-CTR000012543 . Registered on 10 December 2013. |
topic |
Polyclonal intravenous immunoglobulin G IVIG Propensity score Sepsis Infection Adjunctive therapy |
url |
http://link.springer.com/article/10.1186/s13054-017-1764-4 |
work_keys_str_mv |
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doaj-b1d2eeff044f4f9b9210710ad1329cb72020-11-24T21:25:20ZengBMCCritical Care1364-85352017-07-012111910.1186/s13054-017-1764-4Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shockYusuke Iizuka0Masamitsu Sanui1Yusuke Sasabuchi2Alan Kawarai Lefor3Mineji Hayakawa4Shinjiro Saito5Shigehiko Uchino6Kazuma Yamakawa7Daisuke Kudo8Kohei Takimoto9Toshihiko Mayumi10Takeo Azuhata11Fumihito Ito12Shodai Yoshihiro13Katsura Hayakawa14Tsuyoshi Nakashima15Takayuki Ogura16Eiichiro Noda17Yoshihiko Nakamura18Ryosuke Sekine19Yoshiaki Yoshikawa20Motohiro Sekino21Keiko Ueno22Yuko Okuda23Masayuki Watanabe24Akihito Tampo25Nobuyuki Saito26Yuya Kitai27Hiroki Takahashi28Iwao Kobayashi29Yutaka Kondo30Wataru Matsunaga31Sho Nachi32Toru Miike33Hiroshi Takahashi34Shuhei Takauji35Kensuke Umakoshi36Takafumi Todaka37Hiroshi Kodaira38Kohkichi Andoh39Takehiko Kasai40Yoshiaki Iwashita41Hideaki Arai42Masato Murata43Masahiro Yamane44Kazuhiro Shiga45Naoto Hori46Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical CenterDepartment of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical CenterDepartment of Clinical Epidemiology and Health Economics, School of Public Health, University of TokyoDepartment of Surgery, Jichi Medical UniversityEmergency and Critical Care Center, Hokkaido University HospitalIntensive Care Unit, Department of Anesthesiology, Jikei University School of MedicineIntensive Care Unit, Department of Anesthesiology, Jikei University School of MedicineDivision of Trauma and Surgical Critical Care, Osaka General Medical CenterDivision of Emergency and Critical Care Medicine, Tohoku University Graduate School of MedicineDepartment of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of MedicineDepartment of Emergency Medicine, University of Occupational and Environmental HealthDivision of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of MedicineDepartment of Emergency and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi HospitalPharmaceutical Department, JA Hiroshima General HospitalDepartment of Emergency and Critical Care Medicine, Saitama Red Cross HospitalDepartment of Emergency and Critical Care Medicine, Wakayama Medical UniversityDepartment of Emergency Medicine and Critical Care Medicine, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi HospitalEmergency and Critical Care Center, Kyushu University HospitalDepartment of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka UniversityEmergency Department, Ibaraki Prefectural Central HospitalDivision of Trauma and Surgical Critical Care, Osaka General Medical CenterDivision of Intensive Care, Nagasaki University HospitalDepartment of Emergency and Critical Care Medicine, Tokyo Medical University, Hachioji Medical CenterDepartment of Emergency and Critical Care Medicine, Kyoto Daiichi Red-Cross HospitalIntensive Care Unit, Saiseikai Yokohamasi Tobu HospitalDepartment of Emergency Medicine, Asahikawa Medical UniversityShock and Trauma Center, Nippon Medical School Chiba Hokusoh HospitalEmergency Medicine, Kameda Medical CenterDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School of MedicineEmergency and Critical Care Medicine, Asahikawa Red Cross HospitalDepartment of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the RyukyuDepartment of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical CenterAdvanced Critical Care Center, Gifu University HospitalEmergency and Critical Care Center, Saga University HospitalThe Division of Cardiovascular Disease, Steel Memorial Muroran HospitalDepartment of Emergency Medicine and Critical Care, Sapporo City General HospitalDivision of Emergency Medicine, Ehime University HospitalIntensive Care Unit, Tomishiro Central HospitalDepartment of Emergency Medicine, Akashi City HospitalDepartment of Emergency and Critical Care, Sendai City HospitalEmergency Department, Hakodate Municipal HospitalEmergency and Critical Care Center, Mie University HospitalDepartment of Emergency Medicine, University of Occupational and Environmental HealthDepartment of Emergency Medicine, Gunma UniversityDepartment of Anesthesia and Intensive Care, KKR Sapporo Medical CenterEmergency and Critical Care Center, Seirei Mikatahara General HospitalIntensive Care Unit, Hyogo College of MedicineAbstract Background The administration of low-dose intravenous immunoglobulin G (IVIgG) (5 g/day for 3 days; approximate total 0.3 g/kg) is widely used as an adjunctive treatment for patients with sepsis in Japan, but its efficacy in the reduction of mortality has not been evaluated. We investigated whether the administration of low-dose IVIgG is associated with clinically important outcomes including intensive care unit (ICU) and in-hospital mortality. Methods This is a post-hoc subgroup analysis of data from a retrospective cohort study, the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study. The JSEPTIC DIC study was conducted in 42 ICUs in 40 institutions throughout Japan, and it investigated associations between sepsis-related coagulopathy, anticoagulation therapies, and clinical outcomes of 3195 adult patients with sepsis and septic shock admitted to ICUs from January 2011 through December 2013. To investigate associations between low-dose IVIgG administration and mortalities, propensity score-based matching analysis was used. Results IVIgG was administered to 960 patients (30.8%). Patients who received IVIgG were more severely ill than those who did not (Acute Physiology and Chronic Health Evaluation (APACHE) II score 24.2 ± 8.8 vs 22.6 ± 8.7, p < 0.001). They had higher ICU mortality (22.8% vs 17.4%, p < 0.001), but similar in-hospital mortality (34.4% vs 31.0%, p = 0.066). In propensity score-matched analysis, 653 pairs were created. Both ICU mortality and in-hospital mortality were similar between the two groups (21.0% vs 18.1%, p = 0.185, and 32.9% vs 28.6%, p = 0.093, respectively) using generalized estimating equations fitted with logistic regression models adjusted for other therapeutic interventions. The administration of IVIgG was not associated with ICU or in-hospital mortality (odds ratio (OR) 0.883; 95% confidence interval (CI) 0.655–1.192, p = 0.417, and OR 0.957, 95% CI, 0.724–1.265, p = 0.758, respectively). Conclusions In this analysis of a large cohort of patients with sepsis and septic shock, the administration of low-dose IVIgG as an adjunctive therapy was not associated with a decrease in ICU or in-hospital mortality. Trial registration University Hospital Medical Information Network Individual Clinical Trials Registry, UMIN-CTR000012543 . Registered on 10 December 2013.http://link.springer.com/article/10.1186/s13054-017-1764-4Polyclonal intravenous immunoglobulin GIVIGPropensity scoreSepsisInfectionAdjunctive therapy |