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Early therapy with IgM-enriched polyclonal immunoglobulin in patients with septic shock

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Abstract

Purpose

To determine whether there was an association between adjunctive therapy with IgM-enriched immunoglobulin (IgM) and the 30-day mortality rate in patients with septic shock.

Methods

In 2008 we introduced IgM as a possible adjunctive therapy to be provided within 24 h after shock onset in the management protocol for patients with septic shock. In this retrospective study we included the adult patients suitable for IgM therapy admitted to our ICU from January 2008 to December 2011. An unadjusted comparison between patients who did or did not receive IgM therapy, a multivariate logistic model adjusted for confounders and propensity score-based matching were used to evaluate the association between early IgM treatment and mortality.

Results

One hundred and sixty-eight patients were included in the study. Of these, 92 (54.8 %) received IgM therapy. Patients who did or did not receive IgM were similar with regards to infection characteristics, severity scores and sepsis treatment bundle compliance. Patients who received IgM were more likely to have blood cultures before antibiotics and to attain a plateau inspiratory pressure less than 30 cmH2O (p < 0.05). The 30-day mortality rate was reduced by 21.1 % (p < 0.05) in the group that received IgM compared to the group that did not. The multivariate adjusted regression model (OR 0.17; CI 95 % 0.06–0.49; p = 0.001) and the propensity score-based analysis (OR 0.35; CI 95 % 0.14–0.85; p = 0.021) confirmed that IgM therapy was associated with reduced mortality at 30 days after the onset of septic shock.

Conclusions

Our experience indicates that early adjunctive treatment with IgM may be associated with a survival benefit in patients with septic shock. However, additional studies are needed to better evaluate the role of IgM therapy in the early phases of septic shock.

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Acknowledgments

We wish to thank Mervyn Singer and Matteo Bassetti for critical revisions of the manuscript and their clever suggestions.

Conflicts of interest

Cavazzuti Ilaria and Massimo Girardis have consulted for Biotest-Germany, the remaining authors have no competing interests.

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Authors and Affiliations

  1. Intensive Care Unit, Department of Anaesthesiology and Intensive Care, University Hospital of Modena, L.go del Pozzo, 71, 41100, Modena, Italy

    Ilaria Cavazzuti, Giulia Serafini, Stefano Busani, Laura Rinaldi, Emanuela Biagioni, Marta Buoncristiano & Massimo Girardis

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  1. Ilaria Cavazzuti
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  2. Giulia Serafini
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  3. Stefano Busani
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  4. Laura Rinaldi
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  6. Marta Buoncristiano
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  7. Massimo Girardis
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Corresponding author

Correspondence to Massimo Girardis.

Additional information

Take-home message: Adjunctive treatment with IgM early on resulted in a 20 % reduction of the absolute 30-day risk of mortality in patients with septic shock treated using evidence-based guidelines.

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Cavazzuti, I., Serafini, G., Busani, S. et al. Early therapy with IgM-enriched polyclonal immunoglobulin in patients with septic shock. Intensive Care Med 40, 1888–1896 (2014). https://doi.org/10.1007/s00134-014-3474-6

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  • DOI: https://doi.org/10.1007/s00134-014-3474-6

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