6 research outputs found
The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure
Immunoglobulines; SĂšpsia; SupervivĂšnciaInmunoglobulinas; Sepsis; SupervivenciaImmunoglobulins; Sepsis; SurvivalBackground
Pre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity.
Methods
This was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score at ICU admission (SOFA < 8, n = 122 and SOFA â„ 8, n = 156), and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by KaplanâMeier and multivariate logistic regression analysis.
Results
ICU/hospital mortality in the SOFA < 8 group was 14.8/23.0%, compared to 30.1/35.3% in the SOFA â„ 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG < 407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated with a reduction in the survival mean time of 6.6 days in the first 28 days and was a robust predictor of mortality risk either during the acute or during the post-acute phase of the disease (OR for ICU mortality: 13.79; OR for hospital mortality: 7.98). This predictive ability remained in the absence of prior immunosuppression (OR for ICU mortality: 17.53; OR for hospital mortality: 5.63). Total IgG < 407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA â„ 8 group, we found no immunoglobulin thresholds associated with neither ICU nor hospital mortality.
Conclusions
Endogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortalities.Funding was provided by SACYL (Grant No. BOCYL-D-26072010), Instituto de Salud Carlos III (Grant Nos. EMER 07/050, PI12-01815)
Circulating neutrophil counts and mortality in septic shock
ProducciĂłn CientĂficaPolynuclear neutrophils can play dual roles in sepsis:
on the one hand they mediate major antimicrobial
activities and on the other hand they can contribute
to the development of multiple organ failure [1].
Nonetheless, in spite of the importance of these cells
in sepsis, the influence of the circulating neutrophil
count (CNC) on the prognosis of septic patients with
this pathology has not been properly evaluated.
We analyzed the association between CNC and outcome
in two cohorts of patients with diagnostic criteria
of septic shock (SS) [2]: the first was recruited in the
context of a single center study (EXPRESS study, discovery
cohort, n = 195; Table 1), and the second in the context
of a multi-centric study (GRECIA study, validation
cohort, n = 194; Table 2). Written informed consent was
obtained from each patient or their legal representative.
The two studies were approved by the Research Ethics
Committee of the Hospital ClĂnico Universitario, Valladolid,
Spain (for the EXPRESS study) and Hospital Universitario
RĂo Hortega, Valladolid, Spain (coordinating
center for the GRECIA study).Instituto de Salud Carlos III (grant PI 10/01362)Junta de Castilla y LeĂłn (grant BOCYL-D-26072010
The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure
Pre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity. This was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score at ICU admission (SOFA < 8, n = 122 and SOFA â„ 8, n = 156), and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by Kaplan-Meier and multivariate logistic regression analysis. ICU/hospital mortality in the SOFA < 8 group was 14.8/23.0%, compared to 30.1/35.3% in the SOFA â„ 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG < 407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated with a reduction in the survival mean time of 6.6 days in the first 28 days and was a robust predictor of mortality risk either during the acute or during the post-acute phase of the disease (OR for ICU mortality: 13.79; OR for hospital mortality: 7.98). This predictive ability remained in the absence of prior immunosuppression (OR for ICU mortality: 17.53; OR for hospital mortality: 5.63). Total IgG < 407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA â„ 8 group, we found no immunoglobulin thresholds associated with neither ICU nor hospital mortality. Endogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortalities. The online version of this article (doi:10.1186/s13613-017-0268-3) contains supplementary material, which is available to authorized user
MOESM1 of The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure
Additional file 1. Mean survival time (days) in the SOFA <8 group based on immunoglobulin thresholds. Differences between groups were assessed using the log-rank test. Î (days) represents [(mean survival time in patients with levels of immunoglobulin above the threshold) â (mean survival time in patients with levels of immunoglobulin below the threshold)]. Time was censored at 28 days following ICU admissio