Gamma-globulin levels in patients with community-acquired septic shock.
Polyclonal intravenous immunoglobulins (IVIGs) can modulate the host immune response and may improve outcomes in some patients. In this prospective, noninterventional study, we assessed the time-course of gamma-globulin concentrations in 21 patients with septic shock and evaluated the relationship of gamma-globulin concentrations to disease severity and outcome. Six patients (28.5%) died. Sixteen patients (76%) had hypo-gamma-globulinemia at admission: 12 (57%) had low IgG concentrations (G650 mg/dL), 2 had low IgA concentrations (G70 mg/dL), and 9 had low IgM concentrations (G40 mg/dL). Two patients had low concentrations of all three gamma-globulins; these patients both died from refractory shock within 2 days. Patients with low IgG concentrations were indistinguishable at baseline from patients with normal IgG concentrations but had fewer vasopressor-free days (over 28 days) and more frequently developed acute lung injury/acute respiratory distress syndrome (3/9 vs. 10/12; P = 0.02). All deaths occurred in the patients with low IgG concentrations (6/ 12 vs. 0/9). There was a variable increase in kappa and lambda free light chains, a marker of gamma-globulin synthesis, over time with no significant difference between low and normal IgG groups. This pilot study indicates that low concentrations of gamma-globulins, especially IgG, are common in patients with community-acquired septic shock and persist over time even when sepsis resolves. Despite similar presentation, patients with hypo-IgG had greater vasopressor requirements, were more likely to develop acute lung injury/acute respiratory distress syndrome, and had higher mortality. Patients with low IgG concentrations may represent a logical target group to study the effects of Ig supplementation in septic shock.
Taccone
Fabio Silvio
FS
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, Brussels, Belgium. ftaccone@ulb.ac.be
Stordeur
Patrick
P
De Backer
Daniel
D
Creteur
Jacques
J
Vincent
Jean-Louis
JL
D000368:Aged; D017714:Community-Acquired Infections / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D007075:Immunoglobulin M / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000209:etiology; D012772:Shock, Septic / Q000150:complications / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D005719:gamma-Globulins / Q000378:metabolism*
D007074:Immunoglobulin G; D007075:Immunoglobulin M; D014662:Vasoconstrictor Agents; D005719:gamma-Globulins