title: Relationship between the timing of administration of IgM and IgA enriched immunoglobulins in patients with severe sepsis and septic shock and the outcome: a retrospective analysis.
abstract: OBJECTIVE
  Because the use of IgM and IgA enriched polyclonal intravenous immunoglobulins (eIg) is a standard of care in critically ill patients admitted to our intensive care unit (ICU) with the diagnosis of severe sepsis or septic shock, we investigated if the delay from the onset of severe sepsis and septic shock and their administration could influence the outcome.
  
  
  METHODS
  The medical records of all patients with severe sepsis or septic shock admitted to our ICU from July 2004 through October 2009 and treated with eIg (Pentaglobin®; Biotest, Dreieich, Germany) were retrospectively examined.
  
  
  RESULTS
  A total of 129 adult patients with severe sepsis or septic shock were considered eligible. Thirty-two percent of patients died during the ICU stay. Survivors were given eIg significantly earlier than nonsurvivors (23 vs 63 hours, P < .05). The delay in the administration of eIg and the Simplified Acute Physiology Score II were the only variables that entered stepwise a propensity score-adjusted logistic model. The delay in the administration of eIg was a significant predictor of the odds of dying during the ICU stay (odds ratio for 1 hour of delay, 1.007; P < .01; 99% confidence interval from 1.001 to 1.010) and proved to be independent from the Simplified Acute Physiology Score II and other variables.
  
  
  CONCLUSIONS
  The efficacy of eIg, being maximal in early phases of severe sepsis and/or septic shock, is probably time dependent.
authors: Department of Anesthesia and Intensive Care, Cattinara University Hospital, Trieste, Italy. berlot@inwind.it
authors: Giorgio
authors: G
authors: Berlot
authors: Michele C
authors: MC
authors: Vassallo
authors: Nicola
authors: N
authors: Busetto
authors: Monica
authors: M
authors: Bianchi
authors: Francesca
authors: F
authors: Zornada
authors: Ivana
authors: I
authors: Rosato
authors: Fabiana
authors: F
authors: Tartamella
authors: Lara
authors: L
authors: Prisco
authors: Federica
authors: F
authors: Bigotto
authors: Tiziana
authors: T
authors: Bigolin
authors: Massimo
authors: M
authors: Ferluga
authors: Irene
authors: I
authors: Batticci
authors: Enrico
authors: E
authors: Michelone
authors: Massimo
authors: M
authors: Borelli
authors: Marino
authors: M
authors: Viviani
authors: Ariella
authors: A
authors: Tomasini
mesh_terms: D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007070:Immunoglobulin A / Q000008:administration & dosage*; D007075:Immunoglobulin M / Q000008:administration & dosage*; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007070:Immunoglobulin A; D007075:Immunoglobulin M; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors