title: Gamma-globulin levels in patients with community-acquired septic shock.
abstract: 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.
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, Brussels, Belgium. ftaccone@ulb.ac.be
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.forename: Patrick
authors.initials: P
authors.lastname: Stordeur
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
authors.forename: Jacques
authors.initials: J
authors.lastname: Creteur
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: 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*
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M; D014662:Vasoconstrictor Agents; D005719:gamma-Globulins