1. The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure
- Author
-
Adriele Prina-Mello, Eduardo Anton, Jesús Blanco, Rubén Herrán-Monge, Ana Rodriguez-Fernandez, Ignacio Martin-Loeches, Wysali Trapiello, Jordi Solé-Violán, Antonio Artigas, David Andaluz-Ojeda, Arturo Muriel-Bombín, Ana Loza, B. Suberviola, Jesus F. Bermejo-Martin, Pedro Merino, Ricard Ferrer, Leonardo Lorente, Pablo Garcia-Olivares, Eduardo Tamayo, Institut Català de la Salut, [Martin-Loeches I] Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s University Hospitals Dublin, James’s St, Ushers, Dublin 8, Ireland. [Muriel-Bombín A] Intensive Care Department, Hospital Universitario Río Hortega de Valladolid, Calle Dulzaina, 2, 47012 Valladolid, Spain. [Ferrer R] Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Shock, Disfunció Orgànica i Ressucitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Artigas A] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain. CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, C/Sinesio Delgado,4, 28029 Madrid, Spain. [Sole-Violan J] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Dr Negrin, Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Las Palmas, Spain. [Lorente L] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Universitario de Canarias, Carretera de Ofra, s/n, 38320 San Cristóbal de La Laguna, Santa Cruz De Tenerife, Spain. [Suberviola B] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Spain. [Loza AM] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Nuestra Señora de Valme, Av. de Bellavista, s/n, 41014 Seville, Spain. [Garcia-Olivares P] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain. [Anton E] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital de Manacor, Carretera Manacor Alcudia, s/n, 07500 Manacor, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
medicine.medical_specialty ,Immunoglobulin levels ,Survival ,Sepsis mortality ,medicine.medical_treatment ,health care facilities, manpower, and services ,Immunoglobulins ,Endogeny ,infecciones bacterianas y micosis::infección::sepsis [ENFERMEDADES] ,Disease ,Critical Care and Intensive Care Medicine ,Logistic regression ,Severity ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Other subheadings::Other subheadings::Other subheadings::/mortality [Other subheadings] ,Internal medicine ,Anesthesiology ,Medicine ,030212 general & internal medicine ,aminoácidos, péptidos y proteínas::proteínas::proteínas sanguíneas::inmunoproteínas::inmunoglobulinas [COMPUESTOS QUÍMICOS Y DROGAS] ,Septicèmia - Mortalitat ,Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins [CHEMICALS AND DRUGS] ,Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad [Otros calificadores] ,biology ,business.industry ,Research ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,Immunosuppression ,Retrospective cohort study ,lcsh:RC86-88.9 ,medicine.disease ,Surgery ,Intravenous Immunoglobulins ,biology.protein ,Bacterial Infections and Mycoses::Infection::Sepsis [DISEASES] ,Antibody ,Immunoglobulines ,business - 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., The GRECIA study was supported by Proyectos de Investigacion en Biomedicina, Consejeria de Sanidad, JCYL (Grant Code BOCYL-D-26072010). The authors thank also Instituto de Salud Carlos III for their financial support (Grant Code EMER 07/050, ISCIII-FIS-PI12-01815). The funding agencies were not involved neither in the design of the study and collection, nor in the analysis, interpretation of data or manuscript writing.
- Published
- 2017
- Full Text
- View/download PDF