title: Kinetics of circulating immunoglobulin M in sepsis: relationship with final outcome.
abstract: BACKGROUND
  The aim of this study was to investigate the kinetics of immunoglobulin M (IgM) during the different stages of sepsis.
  
  
  METHODS
  In this prospective multicenter study, blood sampling for IgM measurement was done within the first 24 hours from diagnosis in 332 critically ill patients; in 83 patients this was repeated upon progression to more severe stages. Among these 83 patients, 30 patients with severe sepsis progressed into shock and IgM was monitored daily for seven consecutive days. Peripheral blood mononuclear cells (PBMCs) were isolated from 55 patients and stimulated for IgM production.
  
  
  RESULTS
  Serum IgM was decreased in septic shock compared to patients with systemic inflammatory response syndrome (SIRS) and patients with severe sepsis. Paired comparisons at distinct time points of the sepsis course showed that IgM was decreased only when patients deteriorated from severe sepsis to septic shock. Serial measurements in these patients, beginning from the early start of vasopressors, showed that the distribution of IgM over time was significantly greater for survivors than for non-survivors. Production of IgM by PBMCs was significantly lower at all stages of sepsis compared with healthy controls.
  
  
  CONCLUSIONS
  Specific changes of circulating IgM occur when patients with severe sepsis progress into septic shock. The distribution of IgM is lower among non-survivors.
authors.forename: Evangelos J
authors.initials: EJ
authors.lastname: Giamarellos-Bourboulis
authors.forename: Efterpi
authors.initials: E
authors.lastname: Apostolidou
authors.forename: Malvina
authors.initials: M
authors.lastname: Lada
authors.forename: Ioannis
authors.initials: I
authors.lastname: Perdios
authors.forename: Nikolaos K
authors.initials: NK
authors.lastname: Gatselis
authors.forename: Iraklis
authors.initials: I
authors.lastname: Tsangaris
authors.forename: Marianna
authors.initials: M
authors.lastname: Georgitsi
authors.forename: Magdalini
authors.initials: M
authors.lastname: Bristianou
authors.forename: Theodora
authors.initials: T
authors.lastname: Kanni
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Sereti
authors.forename: Miltiades A
authors.initials: MA
authors.lastname: Kyprianou
authors.forename: Anastasia
authors.initials: A
authors.lastname: Kotanidou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
mesh_terms: D018806:APACHE; D000368:Aged; D016638:Critical Illness; D005260:Female; D006115:Greece; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D007963:Leukocytes, Mononuclear; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood* / Q000628:therapy; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D007075:Immunoglobulin M