title: Beneficial role of endogenous immunoglobulin subclasses and isotypes in septic shock.
abstract: OBJECTIVE
  There is increasing evidence on the relationship between endogenously produced immunoglobulins and the clinical outcome in septic shock (SS).
  
  
  METHODS
  Levels of immunoglobulin G (IgG) subclasses, immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin E were measured in plasma from 42 patients with SS and in 36 patients with systemic inflammatory response syndrome at diagnosis. Association of immunoglobulins levels with disease severity and outcome was evaluated.
  
  
  RESULTS
  Eighteen patients with SS finally died. Both patients with systemic inflammatory response syndrome and SS showed subnormal levels of total IgG, IgG2, and IgM. Patients with SS who died showed the lowest levels of total IgG and IgG1. Total IgG, IgG1, IgG2, IgG3, IgG4, and IgA correlated inversely with Acute Physiology and Chronic Health Evaluation II score in SS. Univariate Cox regression analysis showed that levels of IgG1, IgG2, IgG3, IgM, IgA, and total IgG were inversely associated to the probability of death at 28 days. Multivariate analysis showed that IgG1, total IgG, IgM, and IgA behaved as independent protective factors against mortality (hazard ratio, P): 0.23, 0.026; 0.16, 0.028; 0.11, 0.042; 0.05, 0.010, respectively, whereas IgG3 showed a protective trend also.
  
  
  CONCLUSIONS
  Our study evidenced that, in addition to IgG1, other major endogenous immunoglobulins isotypes and subclasses seem to play a beneficial role in SS.
authors.affiliation: Anesthesiology and Reanimation Service, Hospital Clínico Universitario-SACYL, 47005 Valladolid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tamayo
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández
authors.forename: Raquel
authors.initials: R
authors.lastname: Almansa
authors.forename: Elena
authors.initials: E
authors.lastname: Carrasco
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Goncalves
authors.forename: María
authors.initials: M
authors.lastname: Heredia
authors.forename: David
authors.initials: D
authors.lastname: Andaluz-Ojeda
authors.forename: Gabriel
authors.initials: G
authors.lastname: March
authors.forename: Lucia
authors.initials: L
authors.lastname: Rico
authors.forename: Jose I
authors.initials: JI
authors.lastname: Gómez-Herreras
authors.forename: Raúl Ortiz
authors.initials: RO
authors.lastname: de Lejarazu
authors.forename: Jesus F
authors.initials: JF
authors.lastname: Bermejo-Martin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000145:classification / Q000378:metabolism; D007073:Immunoglobulin E / Q000145:classification / Q000378:metabolism; D007074:Immunoglobulin G / Q000145:classification / Q000378:metabolism; D007132:Immunoglobulin Isotypes / Q000145:classification* / Q000378:metabolism*; D007075:Immunoglobulin M / Q000145:classification / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000276:immunology* / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology* / Q000401:mortality
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007132:Immunoglobulin Isotypes; D007075:Immunoglobulin M; D007073:Immunoglobulin E