Effects of the timing of administration of IgM- and IgA-enriched intravenous polyclonal immunoglobulins on the outcome of septic shock patients

Background: The administration of endovenous immunoglobulins in patients with septic shock could be beneficial and preparations enriched with IgA and IgM (ivIgGAM) seem to be more effective than those containing only IgG. In a previous study Berlot et al. demonstrated that early administration of ivIgGAM was associated with lower mortality rate. We studied a larger population of similar patients aiming either to confirm or not this finding considering also the subgroup of patients with septic shock by multidrug-resistant (MDR) pathogens. Methods: Adult patients with septic shock in intensive care unit (ICU) treated with ivIgGAM from August 1999 to December 2016 were retrospectively examined. Collected data included the demographic characteristics of the patients, the diagnosis at admission, SOFA, SAPS II and Murray Lung Injury Score (LIS), characteristics of the primary infection, the adequacy of antimicrobial therapy, the delay of administration of ivIgGAM from the ICU admission and the outcome at the ICU discharge. Parametric and nonparametric tests and logistic regression were used for statistic analysis. Results: During the study period 107 (30%) of the 355 patients died in ICU. Survivors received the ivIgGAM earlier than nonsurvivors (median delay 12 vs 14 h), had significantly lower SAPS II, SOFA and LIS at admission and a lower rate of MDR- and fungal-related septic shock. The appropriateness of the administration of antibiotics was similar in survivors and nonsurvivors (84 vs 79%, respectively, p: n.s). The delay in the administration of ivIgGAM from the admission was associated with in-ICU mortality (odds ratio per 1-h increase = 1.0055, 95% CI 1.003\u20131.009, p < 0.001), independently of SAPS II, LIS, cultures positive for MDR pathogens or fungi and onset of septic shock. Only 46 patients (14%) had septic shock due to MDR pathogens; 21 of them (46%) died in ICU. Survivors had significantly lower SAPS II, SOFA at admission and delay in administration of ivIgGAM than nonsurvivors (median delay 18 vs 66 h). Even in this subgroup the delay in the administration of ivIgGAM from the admission was associated with an increased risk of in-ICU mortality (odds ratio 1.007, 95% CI 1.0006\u20131.014, p = 0.048), independently of SAPS II. Conclusions: Earlier administration of ivIgGAM was associated with decreased risk of in-ICU mortality both in patients with septic shock caused by any pathogens and in patients with MDR-related septic shock

Correction to: Effects of the timing of administration of IgM- and IgA-enriched intravenous polyclonal immunoglobulins on the outcome of septic shock patients

Following publication of the original article [1], we have been notified that the tagging of the author name was done incorrectly in the XML version of the paper. The correct given name is Michele Claudio, and the family name is Vassallo

Nuova generazione di Internet e profili di organizzazione della PA nelle smart City. Aspetti etici e linee prospettiche di regolazione

Digitalizzazione, informatizzazione, innovazione ed integrazione tecnologica sono termini entrati prepotentemente a far parte del lessico quotidiano comune, contribuendo in modo radicale al cambiamento della vita di ciascun individuo ed al contempo proiettandolo verso una nuova dimensione sociale. Tale proiezione può essere definita come un passaggio obbligatorio dalla storia alla iperstoria (“La Quarta Rivoluzione. Come l’infosfera sta trasformando il mondo” (Floridi)). L’internet delle cose (IOT), il web 2.0, il cloud computing, i droni, la guida autonoma e le tante altre novità derivanti dall’ICT (Information Comunication Technology) ci stanno portando inesorabilmente verso la IV rivoluzione. Quindi, insieme alla biosfera, ci immergiamo nella infosfera, che ci avvolge e ci trasmette tutte le informazioni e i dati “processati” da montagne di algoritmi progettati per anticipare i nostri desideri e necessità. Ciò impone una maggiore cura delle questioni etiche, al fine di perseguire il necessario equilibrio tra le opportunità da cogliere e le inevitabili criticità connesse alla tecnologia adottata ed in continua evoluzione Il processo di digitalizzazione, ormai, permea ogni aspetto della vita quotidiana e, in questo quadro di profonda innovazione, anche le città sono destinate a cambiare in modo radicale

Clinical characteristics, management and in-hospital mortality of patients with COVID-19 In Genoa, Italy

To describe clinical characteristics, management and outcome of COVID-19 patients; and to evaluate risk factors for all-cause in-hospital mortality