PMID- 35695053
OWN - NLM
STAT- MEDLINE
DCOM- 20220907
LR  - 20220907
IS  - 2224-5839 (Electronic)
IS  - 2224-5820 (Linking)
VI  - 11
IP  - 8
DP  - 2022 Aug
TI  - Effects of low-dose intravenous immunoglobulin as the adjunctive therapy in 
      septic shock patients with and without hypogammaglobulinemia: a retrospective 
      cohort study.
PG  - 2600-2608
LID - 10.21037/apm-21-3694 [doi]
AB  - BACKGROUND: Intravenous immunoglobulin (IVIG) therapy has a reported adjunctive 
      effect in the treatment of sepsis, but in light of results from a large-scale 
      randomized control trial (RCT), evidence for improved prognosis with IVIG therapy 
      is currently deemed insufficient. In recent years, there have been many reports 
      of low serum immunoglobulin G (IgG) as a poor prognostic factor in septic 
      patients. Under Japan's national health insurance system, IVIG is administered 
      for severe infections at a dose of 5 g/day for three days (total 15 g or 0.3 
      g/kg). At present, IVIG administration is not specifically formulated for septic 
      patients with hypogammaglobulinemia. It is clinically significant to investigate 
      whether serum IgG levels can serve as a biomarker to predict the efficacy of IVIG 
      treatment for septic shock and help to identify those patients who might benefit 
      from an adjunctive IVIG treatment. The purpose of this study was to compare the 
      efficacy of this low-dose IVIG as an adjunctive therapy in septic shock patients 
      with and without hypogammaglobulinemia. METHODS: In this retrospective cohort 
      study, patients who received low-dose IVIG (5 g/day for 3 days) as adjuvant 
      therapy for septic shock were enrolled. These patients were divided into two 
      groups based on a median serum IgG level of 829 mg/dL (<830 mg/dL defined as 
      hypogammaglobulinemia) prior to IVIG administration. To assess the efficacy of 
      low-dose IVIG administration (0.3 g/kg), 28-day survival probability as the 
      primary outcome, and the lengths of artificial ventilation and intensive care 
      unit (ICU) stays as the secondary outcomes were compared using the Kaplan-Meier 
      method, the log-rank test, the Wilcoxon or Mann-Whitney U test. RESULTS: A total 
      of 80 patients with septic shock that underwent IVIG treatment in the ICU were 
      enrolled. These patients were divided into two groups based on a median serum IgG 
      level. Survival probabilities at 28 days were 90.0% and 85.0% in the high- and 
      low-level groups, respectively, and there was no significant difference between 
      the two groups (P=0.457). There are not also significant differences in median 
      lengths of artificial ventilation (6 vs. 9 days, P=0.215) and ICU stays (10 vs. 
      12 days, P=0.199) after IVIG administration. Logistic regression revealed that 
      these clinical outcomes were not associated with serum IgG after adjusting for 
      confounding factors as the antibiotics. CONCLUSIONS: Serum IgG levels was not 
      associated with the clinical outcomes by low-dose IVIG treatment. Our results 
      suggest that the prognosis of low-dose IVIG as adjunctive therapy in patients 
      with septic shock might be no different with and without hypogammaglobulinemia.
FAU - Goto, Koji
AU  - Goto K
AD  - Department of Anesthesiology, Oita Urological Hospital, Oita, Japan; Department 
      of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu, 
      Japan.
FAU - Yasuda, Norihisa
AU  - Yasuda N
AD  - Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita 
      University, Yufu, Japan.
FAU - Sato, Yuhki
AU  - Sato Y
AD  - Faculty of Pharmaceutical Society, Fukuyama University, Fukuyama, Japan.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20220523
PL  - China
TA  - Ann Palliat Med
JT  - Annals of palliative medicine
JID - 101585484
RN  - 0 (Immunoglobulin G)
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - *Agammaglobulinemia/complications/drug therapy
MH  - Cohort Studies
MH  - Humans
MH  - Immunoglobulin G/therapeutic use
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Retrospective Studies
MH  - *Sepsis/complications
MH  - *Shock, Septic/complications/drug therapy
OTO - NOTNLM
OT  - Septic shock
OT  - hypogammaglobulinemia
OT  - intravenous immunoglobulins (IVIGs)
EDAT- 2022/06/14 06:00
MHDA- 2022/09/08 06:00
CRDT- 2022/06/13 05:33
PHST- 2021/12/10 00:00 [received]
PHST- 2022/05/07 00:00 [accepted]
PHST- 2022/06/14 06:00 [pubmed]
PHST- 2022/09/08 06:00 [medline]
PHST- 2022/06/13 05:33 [entrez]
AID - apm-21-3694 [pii]
AID - 10.21037/apm-21-3694 [doi]
PST - ppublish
SO  - Ann Palliat Med. 2022 Aug;11(8):2600-2608. doi: 10.21037/apm-21-3694. Epub 2022 
      May 23.