title: Early therapy with IgM-enriched polyclonal immunoglobulin in patients with septic shock.
abstract: OBJECTIVE
  To determine whether there was an association between adjunctive therapy with IgM-enriched immunoglobulin (IgM) and the 30-day mortality rate in patients with septic shock.
  
  
  METHODS
  In 2008 we introduced IgM as a possible adjunctive therapy to be provided within 24 h after shock onset in the management protocol for patients with septic shock. In this retrospective study we included the adult patients suitable for IgM therapy admitted to our ICU from January 2008 to December 2011. An unadjusted comparison between patients who did or did not receive IgM therapy, a multivariate logistic model adjusted for confounders and propensity score-based matching were used to evaluate the association between early IgM treatment and mortality.
  
  
  RESULTS
  One hundred and sixty-eight patients were included in the study. Of these, 92 (54.8%) received IgM therapy. Patients who did or did not receive IgM were similar with regards to infection characteristics, severity scores and sepsis treatment bundle compliance. Patients who received IgM were more likely to have blood cultures before antibiotics and to attain a plateau inspiratory pressure less than 30 cmH2O (p < 0.05). The 30-day mortality rate was reduced by 21.1% (p < 0.05) in the group that received IgM compared to the group that did not. The multivariate adjusted regression model (OR 0.17; CI 95% 0.06-0.49; p = 0.001) and the propensity score-based analysis (OR 0.35; CI 95% 0.14-0.85; p = 0.021) confirmed that IgM therapy was associated with reduced mortality at 30 days after the onset of septic shock.
  
  
  CONCLUSIONS
  Our experience indicates that early adjunctive treatment with IgM may be associated with a survival benefit in patients with septic shock. However, additional studies are needed to better evaluate the role of IgM therapy in the early phases of septic shock.
authors.affiliation: Intensive Care Unit, Department of Anaesthesiology and Intensive Care, University Hospital of Modena, L.go del Pozzo, 71, 41100, Modena, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cavazzuti
authors.forename: Giulia
authors.initials: G
authors.lastname: Serafini
authors.forename: Stefano
authors.initials: S
authors.lastname: Busani
authors.forename: Laura
authors.initials: L
authors.lastname: Rinaldi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Biagioni
authors.forename: Marta
authors.initials: M
authors.lastname: Buoncristiano
authors.forename: Massimo
authors.initials: M
authors.lastname: Girardis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007075:Immunoglobulin M / Q000627:therapeutic use*; D007167:Immunotherapy / Q000379:methods*; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D012772:Shock, Septic / Q000276:immunology / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate
chemical_list: D007075:Immunoglobulin M