title: Influence of the serum levels of immunoglobulins on clinical outcomes in medical intensive-care patients.
abstract: BACKGROUND
  Endogenous immunoglobulins (Igs) are of fundamental importance in the host defense after microbial infections. However, the therapeutic administration of intravenous IgG (IVIgG) has not yet been shown to improve clinical outcomes in patients suffering from sepsis, and in the case of IgM-containing preparations (IVIgGMA) the positive evidence is only weak. Recently published studies implicate that Ig levels on admission could have an impact on the patient's response to IVIg treatment and on outcomes of critically ill patients.
  
  
  METHODS
  In this noninterventional study, the serum levels of IgG, IgM, and IgA were determined in 340 medical patients on ICU admission, and clinical outcomes were prospectively recorded (ICU mortality, need for renal replacement therapy (RRT), need for mechanical ventilation, substitution of coagulation factors, and amount of red cell transfusions). Patients were prospectively grouped according to their main reason for ICU admission (sepsis, respiratory failure, cardiovascular diseases, acute renal failure, postoperative condition, state after cardiopulmonal resuscitation, gastrointestinal diseases, and others).
  
  
  CONCLUSIONS
  There was no correlation between the Ig levels on admission and ICU mortality neither in the total cohort of medical ICU patients nor in any prespecified subgroup. However, in a logistic regression model that was adjusted for APACHE II score on admission, an increase in serum IgG was associated with a reduced need for mechanical ventilation in patients suffering from cardiovascular disease. On the other hand, in patients suffering from sepsis, an increased level of IgM was linked to an increased administration of coagulation factors.
  
  
  CONCLUSIONS
  Our data do not support the hypothesis that serum levels of immunoglobulins are linked to mortality in medical ICU patients.
authors.affiliation: Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Geier
authors.affiliation: Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schröder
authors.affiliation: Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Tamm
authors.affiliation: Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Dietz
authors.affiliation: Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Nuding
authors.affiliation: Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Holder
authors.affiliation: Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Ö
authors.initials: Ö
authors.lastname: Khandanpour
authors.affiliation: Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Werdan
authors.affiliation: Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany. henning.ebelt@medizin.uni-halle.de.
authors.forename: H
authors.initials: H
authors.lastname: Ebelt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007136:Immunoglobulins
keywords: Clinical outcome; Immune system; Immunoglobulins; Intensive care; Mortality; Sepsis