Abstract
Patients in septic shock with low IgG and IgM serum concentrations have higher mortality rates compared to those with normal immunoglobulin levels and, therefore, there is a rational explanation to administer intravenous IgM-enriched immunoglobulins to septic patients in ICU. Aim of this study is to evaluate the effectiveness of intravenous IgM-enriched immunoglobulins in decreasing several sepsis biomarker concentrations. 26 sepsis patients were enrolled in this observational cohort study and Nitric Oxide, Endocan, Pentraxin and presepsin serum levels were measured during their first 3 days of ICU stay. The use of intravenous IgM-enriched immunoglobulins did not influence the temporal evolution of SOFA, Nitric Oxide, Endocan, Pentraxin and Presepsin in the first 3 days of ICU stay in a statistically significant manner, even if Presepsin decreased of 25% from day 1 to day 2 in the Pentaglobin group. It seems possible that Pentaglobin infusion reduces the Presepsin level in a more effective way if it were administered to a younger population (p = 0.012). In conclusion, age modifies the response of Presepsin to Pentaglobin and is a critical variable when investigating the effect of intravenous IgM-enriched immunoglobulins on sepsis.
Highlights
Patients are predisposed to an increased rate of sepsis because of their state of immunosenescence and they suffer a more prolonged proinflammatory response compared to younger patients
We aimed to prove the efficacy of intravenous IgM-enriched immunoglobulins by using indirect indicators of outcome; our hypothesis is that treated patients should benefit of a lower level of sepsis biomarkers, compared to not treated subjects
15 septic shock patients were treated with Pentaglobin and 11 patients were treated with standard therapy
Summary
Patients are predisposed to an increased rate of sepsis because of their state of immunosenescence and they suffer a more prolonged proinflammatory response compared to younger patients. Patients in septic shock with low IgG and IgM serum concentrations have higher mortality rates compared to those with normal immunoglobulin levels (Myrianthefs et al, 2010). Many preparations, including intravenous IgM-enriched immunoglobulins, are available with a growing number of accepted uses, since these products are generally well-tolerated and with few side effects (Biagioni et al, 2021). Polyclonal intravenous immunoglobulins have pleiotropic effects on inflammatory and immune mechanisms and have been proposed as adjuvant therapy to modulate inflammatory processes. During the SARS epidemic in Hong Kong, e.g., in selected cases, Tsui et al (2003), and Ho et al (2004) administered intravenous IgM-enriched immunoglobulins (Pentaglobin). One case of Intravenous IgM-Enriched Immunoglobulins Reduce Presepsin
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