Higher levels of IgA and IgG at sepsis onset are associated with higher mortality: results from the Albumin Italian Outcome Sepsis (ALBIOS) trial.
IgA
IgG
IgM Immunoglobulins
Mortality
Sepsis
Septic shock
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
26 Nov 2021
26 Nov 2021
Historique:
received:
14
07
2021
accepted:
12
11
2021
entrez:
26
11
2021
pubmed:
27
11
2021
medline:
27
11
2021
Statut:
epublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 34825972
doi: 10.1186/s13613-021-00952-z
pii: 10.1186/s13613-021-00952-z
pmc: PMC8626546
doi:
Banques de données
ClinicalTrials.gov
['NCT00707122']
Types de publication
Journal Article
Langues
eng
Pagination
161Subventions
Organisme : agenzia italiana del farmaco, ministero della salute
ID : FARM6JS3R5
Organisme : ministero della salute
ID : RF-2011-02348358
Organisme : grifols
ID : ALBUS Grifols Award
Organisme : grifols
ID : 2015
Informations de copyright
© 2021. The Author(s).
Références
Curr Opin Crit Care. 2001 Oct;7(5):354-61
pubmed: 11805533
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Int Immunopharmacol. 2011 Dec;11(12):2086-90
pubmed: 21924385
Crit Care. 2012 Dec 12;16(2):206
pubmed: 22424150
Eur J Clin Invest. 2017 Jan;47(1):73-83
pubmed: 27864924
Clin Chem Lab Med. 2015 Nov;53(12):e359-61
pubmed: 25720098
Eur J Clin Invest. 2020 Oct;50(10):e13333
pubmed: 32585739
Clin Exp Immunol. 2008 Jan;151(1):42-50
pubmed: 18005364
Crit Care Med. 2018 May;46(5):e404-e410
pubmed: 29481425
Shock. 2009 Oct;32(4):379-85
pubmed: 19295479
Crit Care Clin. 2018 Jan;34(1):97-106
pubmed: 29149944
Clin Microbiol Infect. 2016 Jun;22(6):499-506
pubmed: 26850828
Science. 2012 Feb 3;335(6068):597-601
pubmed: 22245738
Ann Intensive Care. 2017 Dec;7(1):44
pubmed: 28429310
Crit Care. 2013 Oct 21;17(5):R247
pubmed: 24144038
Crit Care. 2011;15(5):R243
pubmed: 22018048
Med Klin Intensivmed Notfmed. 2017 Jun;112(5):462-470
pubmed: 27677760
N Engl J Med. 2014 Apr 10;370(15):1412-21
pubmed: 24635772
Crit Care Med. 2007 Dec;35(12):2686-92
pubmed: 18074465
Crit Care Med. 2017 Nov;45(11):1829-1836
pubmed: 28742550
Crit Care. 2014 Jan 07;18(1):R6
pubmed: 24393424
N Engl J Med. 2013 Aug 29;369(9):840-51
pubmed: 23984731
Eur J Clin Chem Clin Biochem. 1996 Jun;34(6):517-20
pubmed: 8831057
JAMA. 2019 May 28;321(20):2003-2017
pubmed: 31104070
Nat Rev Microbiol. 2008 Feb;6(2):132-42
pubmed: 18197169
Clin Exp Immunol. 1996 May;104 Suppl 1:3-9
pubmed: 8625540
Chest. 1992 Jun;101(6):1644-55
pubmed: 1303622
Front Med (Lausanne). 2021 Feb 18;8:616511
pubmed: 33681248
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
Intensive Care Med. 2015 Aug;41(8):1393-401
pubmed: 25971390
Clin Infect Dis. 2000 Nov;31(5):1175-82
pubmed: 11073749
Intensive Care Med. 1996 Jul;22(7):707-10
pubmed: 8844239
Eur J Intern Med. 2020 Aug;78:113-120
pubmed: 32409206
Crit Care. 2015 Feb 26;19:90
pubmed: 25882822
J Intern Med. 2021 Feb;289(2):179-192
pubmed: 32686253
Open Forum Infect Dis. 2018 Nov 19;5(12):ofy313
pubmed: 30555852
J Intern Med. 2014 Oct;276(4):404-12
pubmed: 24815605
Lancet Respir Med. 2017 Oct;5(10):816-826
pubmed: 28864056