title: Use of polyclonal immunoglobulins as adjunctive therapy for sepsis or septic shock.
abstract: OBJECTIVE
  There is ongoing debate about the efficacy of polyvalent immunoglobulins as adjunctive therapy for sepsis or septic shock. Two meta-analyses by the Cochrane collaboration calculated a significant reduction in mortality. However, data of the largest study were missing in one, and a subset of four high-quality studies failed to show an effect in the other. To broaden the database, we performed a meta-analysis of all randomized controlled studies published so far.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane Library of randomized trials, and personal files.
  
  
  METHODS
  Meta-analysis of all published randomized controlled studies published on polyvalent immunoglobulins (Ig) for treatment of sepsis or septic shock in adults, children, or neonates.
  
  
  METHODS
  Twenty-seven trials with a total of 2,202 patients fulfilled the inclusion criteria.
  
  
  RESULTS
  As the immunologic state of neonates is different than that of adults or older children, data were evaluated separately for each group. Fifteen trials on 1,492 adults could be included. The pooled effect on mortality was a relative risk of death (RR) of 0.79 (95% confidence interval [CI] 0.69-0.90, p <or= .0003). There was a strong trend in favor of an immunoglobulin preparation enriched with IgA and IgM (IgGAM) (RR = 0.66, 95% CI 0.51-0.84, p <or= .0009) compared with preparations containing only IgG (RR = 0.85, 95% CI 0.73-0.99, p <or= .04). In 12 trials on 710 neonates, the pooled effect on mortality was 0.56 (95% CI 0.42-0.74, p <or= .0001). There was also a positive although less pronounced trend favoring the effect of IgGAM (RR = 0.50, 95% CI 0.34-0.73, p <or= .0003) compared with IgG (RR = 0.63, 95% CI 0.42-0.96, p <or= .03). A sensitivity analysis selecting eight trials in adults and ten in neonates of highest methodological quality confirmed these results.
  
  
  CONCLUSIONS
  Polyvalent immunoglobulins exert a significant effect on mortality in sepsis and septic shock, with a trend in favor of IgGAM.
authors: Department of Intensive Care, University Medical Centre, Hamburg-Eppendorf, Germany. kreymann@uke.uni-hamburg.de
authors: K Georg
authors: KG
authors: Kreymann
authors: Geraldine
authors: G
authors: de Heer
authors: Axel
authors: A
authors: Nierhaus
authors: Stefan
authors: S
authors: Kluge
mesh_terms: D000328:Adult; D002648:Child; D017052:Hospital Mortality; D006801:Humans; D007070:Immunoglobulin A / Q000627:therapeutic use*; D007075:Immunoglobulin M / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous / Q000276:immunology / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000276:immunology / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy; D015996:Survival Rate
chemical_list: D007070:Immunoglobulin A; D007075:Immunoglobulin M; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors