Abstract
Sepsis is a life-threatening organ dysfunction, defined by a dysregulated host immune response to infection. During sepsis, the finely tuned system of immunity, inflammation and anti-inflammation is disturbed in a variety of ways. Both pro-inflammatory and anti-inflammatory pathways are upregulated, activation of the coagulation cascade and complement and sepsis-induced lymphopenia occur. Due to the manifold interactions in this network, the use of IgM-enriched intravenous immunoglobulins seems to be a promising therapeutic approach. Unfortunately, there is still a lack of evidence-based data to answer the important questions of appropriate patient populations, optimal timing and dosage of intravenous immunoglobulins. With this review, we aim to provide an overview of the role of immunoglobulins, with emphasis on IgM-enriched formulations, in the therapy of adult patients with sepsis and septic shock.
Highlights
Sepsis is a life-threatening, dysregulated immune response that occurs, when the body’s defensive reactions against infection damage its own tissues and organs [1]
The concept that acquired immunosuppression is a significant event in sepsis and septic shock leads to the hypothesis that stimulation of the immune response and/or substitution of individual immune system components could be a promising therapeutic approach
The combination of several Ig parameters was found to be significantly associated with an unfavourable outcome when levels of IgA, IgG and immunoglobulin M (IgM) were below specified cut offs [110]. This finding is consistent with the evidence from a retrospective analysis of 129 patients with septic shock treated with IgGAM, where a survival benefit was associated with the start of treatment within the first 23 h [111]
Summary
Sepsis is a life-threatening, dysregulated immune response that occurs, when the body’s defensive reactions against infection damage its own tissues and organs [1]. In 2017, an estimated 48.9 million cases of sepsis were recorded worldwide with 11.0 million sepsis-related deaths, representing 19.7% of all global deaths [2]. Due to continuous progress in the understanding of the underlying pathology and immunological mechanisms, the definition of sepsis as a clinical syndrome is subject to constant development. The current consensus definition (“Sepsis-3”) emphasizes for the first time the crucial role of the innate and adaptive immune response in the development of the clinical syndrome. Despite the enormous efforts made during the last three decades of clinical and experimental research, the available therapeutic armamentarium to positively affect the course of the disease remains restricted. The mortality of septic shock, the most severe subgroup of sepsis, lies in the range of more than 50% in North America and Europe [3]
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