[Supplemental infection therapy with i.v. immunoglobulins (polyvalent IgG and Pseudomonas IgG)--results of an observational case study with 163 patients].
The impact of i.v. immunoglobulin (IVIG) therapy on the survival of adult septic patients cannot yet be considered either proved or disproved. To define optimal criteria for a large multicenter placebo-controlled trial, a multicenter observational study was carried out in 163 medical and surgical patients exhibiting a total of 173 episodes of sepsis and septic shock [Elebute (El) sepsis score; 19 +/- 0.5). The effects of supplemental IVIG treatment (unmodified polyvalent IgG, pH 4.25, n = 123; for Pseudomonas sepsis, n = 50, Pseudomonas IgG) on multiple-organ failure (MOF) were investigated according to changes in the APACHE II score (AP) (pretreatment value 23.7 +/- 0.6). In 44% of the cases ("responders"), a prompt improvement in AP (defined as a decrease of greater than or equal to 4) was evident from day 0 to day 4 after the onset of therapy, thus showing a close temporal relationship to IVIG administration. This improvement, associated with an improved prognosis (mortality, 24% vs 55%), was found in all subgroups, most importantly, polyvalent IgG vs Pseudomonas IgG treatment; medical vs surgical patients; moderate vs severe MOF; and gram-positive vs gram-negative septicemia. Thus, all of these patients should be included in future placebo-controlled, randomized IVIG trials.(ABSTRACT TRUNCATED AT 250 WORDS)
Pilz
G
G
Medizinische Klinik I, Universität München.
Kääb
S
S
Bujdoso
O
O
Neumann
R
R
Werdan
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003422:Critical Care; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000276:immunology*; D012772:Shock, Septic / Q000276:immunology / Q000628:therapy*
D000900:Anti-Bacterial Agents; D007074:Immunoglobulin G
Additive Sepsistherapie mit i.v.-Immunglobulinen (polyvalentes IgG und Pseudomonas IgG)--Ergebnisse einer Fallbeobachtungsstudie mit 163 Patienten.