The effects of IgM-enriched immunoglobulin preparations in patients with severe sepsis [ISRCTN28863830].
BACKGROUND
In this prospective, randomized controlled study, we aimed to evaluate the effect of IgM-enriched immunoglobulin treatment on progression of organ failure and septic shock in patients with severe sepsis.


METHODS
Forty-two patients with severe sepsis were enrolled in the study. Patients in the study group (n = 21) received an intravenous immunoglobulin preparation (Pentaglobin in addition to standard therapy. Pentaglobin therapy was commenced on the day of diagnosis of severe sepsis: 5 ml/kg per day Pentaglobin (38 g/l IgG, 6 g/l IgM, and 6 g/l IgA) was infused over 6 hours and repeated for 3 consecutive days. Patients in the control group (n = 18) received standard sepsis therapy, but no immunoglobulin administration. Blood samples for procalcitonin (PCT) measurements were taken daily for 8 days. Severity of critical illness and development of organ failure were assessed by obtaining daily acute physiological and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores.


CONCLUSIONS
Procalcitonin levels showed a statistically significant decrease in the Pentaglobin group (P < 0.001); however, an improvement in SOFA scores could not be demonstrated. Procalcitonin levels and SOFA scores did not change significantly in the control group. Septic shock incidence (38% versus 57%) and 28-day mortality rate (23.8% versus 33.3%) were found to be similar between the Pentaglobin and control groups. The evaluation of serial APACHE II scores did not demonstrate a difference between Pentaglobin and control groups either.


CONCLUSIONS
Present data could not demonstrate any beneficial effects of polyclonal immunoglobulin preparation Pentaglobin on organ morbidity, septic shock incidence and mortality rate in patients with severe sepsis.
Tugrul
Simru
S
Anesthesiology Department, Medical Faculty, Istanbul University, Turkey. mtugrul@isbank.net.tr
Ozcan
Perihan Ergin
PE
Akinci
Ozkan
O
Seyhun
Yalcin
Y
Cagatay
Atahan
A
Cakar
Nahit
N
Esen
Figen
F
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007070:Immunoglobulin A / Q000627:therapeutic use*; D007075:Immunoglobulin M / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000145:classification / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
C000606589:CALCA protein, human; D007070:Immunoglobulin A; D007075:Immunoglobulin M; D011498:Protein Precursors; D002116:Calcitonin; C060166:pentaglobulin; D015740:Calcitonin Gene-Related Peptide