Kinetics of Immunoglobulins in Septic Shock Patients Treated With an IgM- and IgA-Enriched Intravenous Preparation: An Observational Study.

Giorgio Berlot,Antonino Chillemi,Erik Roman-Pognuz,Alice Scamperle,Ariella Tomasini,Silvia Baronio,Roberto Dattola,Irene Longo,Silvia Zanchi,Tatiana Istrati,Mattia Bixio,Giada Quarantotto

doi:10.3389/fmed.2021.605113

Giorgio Berlot, Antonino Chillemi + Show 10 more

Open Access

https://doi.org/10.3389/fmed.2021.605113

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Abstract

Objective: To assess the variations of the blood levels of immunoglobulins (Ig) in septic shock patients treated with an Ig preparation enriched in IgM and IgA (eIg).Design: The blood levels of Ig in survivors (S) and non-survivors (NS) of a group of septic shock patients were measured before the initial administration (D0) and 1 (D1), 4 (D4), and 7 (D7) days thereafter. The SAPS II score, the capillary permeability, the primary site of infection, the antibiotic appropriateness, and the outcome at 28 days were also assessed.Results: In the interval D0–D7, the IgM increased significantly only in the S while remained stable in NS; the IgA significantly increased in both groups; the IgG did not vary significantly in both groups. At D4, the capillary permeability significantly decreased in S but not in NS.Conclusions: The kinetics of the different classes of Ig after eIg were different between S and NS. This could be related either to (a) different capillary permeability in the two groups or to (b) higher Ig consumption in NS. Further studies to confirm the benefits of eIg in the treatment of sepsis syndrome and to define the specific target population and the correct eIg dose are warranted.

Highlights

Despite different studies and meta-analyses demonstrating a better outcome in septic patients who received intravenous immunoglobulins (IvIg) [1,2,3] compared with controls, the Surviving Sepsis Campaign’s guidelines (SSC) recommend against their use due to the lack of trials fulfilling the Evidence-Base Medicine criteria [4]
The elevated concentrations of IgM and IgA (eIg) were administered within 12 h from the diagnosis of septic shock [19]
The SOFA score did not change in both groups during the administration of eIG; after its termination, the SOFA continued to improve in S but worsened in NS (Table 2)

Summary

Introduction

Despite different studies and meta-analyses demonstrating a better outcome in septic patients who received intravenous immunoglobulins (IvIg) [1,2,3] compared with controls, the Surviving Sepsis Campaign’s guidelines (SSC) recommend against their use due to the lack of trials fulfilling the Evidence-Base Medicine criteria [4]. The manufacturer’s indications recommend a standard dose of 250 mg/kg of body weight for 3 consecutive days and the choice to add further doses or not is left to the physician, independently from the initial and end-treatment blood values of the γ-globulins. This approach carries the inherent risk of overor under-administration of the eIg and is far from the concept of precision medicine

Results

Discussion

Conclusion