Efficacy of Intravenous Immunoglobulin Therapy for Patients With Sepsis and Low Immunoglobulin G Levels: A Single-Center Retrospective Study

Masayuki Akatsuka,Yoshiki Masuda,Hiroomi Tatsumi,Tomoko Sonoda

doi:10.1016/j.clinthera.2021.12.008

Masayuki Akatsuka, Yoshiki Masuda + Show 2 more

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https://doi.org/10.1016/j.clinthera.2021.12.008

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Journal: Clinical Therapeutics	Publication Date: Jan 6, 2022
Citations: 5	License type: cc-by

Affiliation: Sapporo Medical University

Abstract

The efficacy of intravenous immunoglobulin (IVIG) administration in patients with sepsis or septic shock remains unclear. A single-center retrospective study was conducted to evaluate the association between IVIG supplementation and favorable outcomes in patients with sepsis and low serum immunoglobulin G (IgG) levels. A total of 239 patients with sepsis were identified whose serum IgG levels were determined upon admission to the intensive care unit between January 2014 and March 2021. Patients with low IgG levels (<670 mg/dL) were divided into the IVIG and non-IVIG groups. Patient data were collected from electronic medical records to evaluate the patients' characteristics, sepsis severity, and prognosis. The primary outcome was 28-day mortality. The propensity score was calculated by using the following variables: age, Sequential Organ Failure Assessment score, immunocompromised status, and serum IgG levels. Logistic regression analysis using propensity score as the adjusted variable was performed to evaluate the outcome. Of 239 patients, 87 had low IgG levels. Of these patients, 47 received IVIG therapy. The 28-day (odds ratio [OR], 0.15; 95% CI, 0.04-0.54; P = 0.004) and 90-day (OR, 0.31; 95% CI, 0.11-0.83; P = 0.020) mortality rates were significantly lower in the IVIG group than in the non-IVIG group. Moreover, the number of days free from renal replacement therapy was significantly higher in the IVIG group than in the non-IVIG group (OR, 1.06; 95% CI, 1.01-1.11; P = 0.025). Serum IgG levels in the IVIG group showed no significant difference compared with those in the non-IVIG group. No significant differences in the patients' characteristics were observed between the groups. This study found that IVIG administration in patients with sepsis and low serum IgG levels was associated with improved prognosis. Further studies are warranted to evaluate the validity of IVIG therapy for patients with sepsis and low serum IgG levels.

Highlights

Sepsis is a complex disorder that develops from a dysregulated host response to infection, leading to the dysfunction of multiple organs and an increased risk of death in the intensive care unit (ICU).[1]
We investigated the efficacy of intravenous immunoglobulin (IVIG) therapy in patients with sepsis who presented with low immunoglobulin G (IgG) levels by determining the association between IVIG supplementation and outcomes
By analyzing recent clinical data from patients who were diagnosed by using the Sepsis-3 definition and treated with a standardized therapeutic strategy, we found that IVIG administration was associated with improved survival rate in patients with sepsis and low serum IgG levels

Summary

Introduction

Sepsis is a complex disorder that develops from a dysregulated host response to infection, leading to the dysfunction of multiple organs and an increased risk of death in the intensive care unit (ICU).[1]. The results of clinical studies on the effects of IVIG therapy in patients with sepsis have been controversial; some studies have reported that the use of IVIG improves patient survival rates,[4,5] others have shown that IVIG administration does not reduce sepsis-related mortality.[6,7,8] A recent meta-analysis found a significant reduction in mortality among patients with sepsis treated with IVIG4; in contrast, results from another meta-analysis that was performed using a randomized controlled trial (RCT) with a low risk for bias indicated no significant benefit.[9]

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