title: IgG2 as an independent risk factor for mortality in patients with community-acquired pneumonia.
abstract: Mortality in patients with community-acquired pneumonia (CAP) remains high despite improvements in treatment.
  
  
  
  To determine immunoglobulin levels in patients with CAP and impact on disease severity and mortality.
  
  
  
  Observational study. Hospitalized patients with CAP were followed up for 30 days. Levels of immunoglobulin G (IgG) and subclasses, immunoglobulin A (IgA) and immunoglobulin M (IgM) were measured in serum within 24 hours of CAP diagnosis.
  
  
  
  Three hundred sixty-two patients with CAP were enrolled -172 ward-treated and 190 intensive care unit-treated. Intensive care unit-treated patients had significantly lower values of IgG1, IgG2, IgG3 subclasses, and IgA than ward-treated patients. Thirty-eight patients died before 30 days. Levels of IgG2 were significantly lower in non-survivors than survivors (P=.004) and IgG2 <301 mg/dL was associated with poorer survival according to both the bivariate (hazard ratio 4.47; P<.001) and multivariate (HR 3.48; P=.003) analyses.
  
  
  
  Patients with CAP with IgG2 levels <301 mg/dL had a poorer prognosis and a higher risk of death. Our study suggests the usefulness of IgG2 to predict CAP evolution and to provide support measures or additional treatment.
authors.affiliation: Unidad Medicina Intensiva, Hospital de Mataró, Barcelona, Spain. Electronic address: mctorre@csdm.cat.
authors.forename: Mari C
authors.initials: MC
authors.lastname: de la Torre
authors.affiliation: Unidad de Investigación, Hospital de Mataró, Barcelona, Spain. Electronic address: epalomera@csdm.cat.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Palomera
authors.affiliation: Unidad de Investigación, Hospital de Mataró, Barcelona, Spain. Electronic address: mserra@csdm.cat.
authors.forename: Mateu
authors.initials: M
authors.lastname: Serra-Prat
authors.affiliation: Unidad Medicina Intensiva, Hospital de Mataró, Barcelona, Spain. Electronic address: eguell@csdm.cat.
authors.forename: Estel
authors.initials: E
authors.lastname: Güell
authors.affiliation: Unidad Medicina Intensiva, Hospital de Mataró, Barcelona, Spain. Electronic address: jyebenes@csdm.cat.
authors.forename: Joan Carles
authors.initials: JC
authors.lastname: Yébenes
authors.affiliation: Unidad de Investigación Médica en Infección e Inmunidad (IMI), Hospital Clínico Universitario de Valladolid SACYL/IECSCYL, Barcelona, Spain. Electronic address: jfbermejo@saludcastillayleon.es.
authors.forename: Jesús F
authors.initials: JF
authors.lastname: Bermejo-Martín
authors.affiliation: Unidad Medicina Intensiva, Hospital de Mataró, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Barcelona, Spain. Electronic address: jalmirall@csdm.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Almirall
mesh_terms: D018806:APACHE; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D013030:Spain; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G
keywords: Community acquired pneumonia; IgG2; Immunoglobulin; Intensive care unit; Mortality; Prognosis