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Influence of the serum levels of immunoglobulins on clinical outcomes in medical intensive-care patients

Einfluss der Immunglobulin-Spiegel im Serum von Patienten auf Intensivstation auf deren klinisches Outcome

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Abstract

Introduction

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).

Results and discussion

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.

Conclusion

Our data do not support the hypothesis that serum levels of immunoglobulins are linked to mortality in medical ICU patients.

Zusammenfassung

Hintergrund

Endogene Immunglobuline spielen eine bedeutende Rolle in der Immunabwehr von mikrobiellen Infektionen. Kürzlich veröffentlichte Studien legen nahe, dass die Immunglobulinspiegel bei stationärer Aufnahme eine prognostische Bedeutung bei Intensivpatienten haben könnten.

Methodik

In einer nicht-interventionellen Studie wurden die Serumspiegel von IgG, IgM und IgA von 340 Patienten bei Aufnahme auf die Intensivstation sowie das Auftreten klinischer Endpunkte (Mortalität auf ITS, Nierenersatzverfahren, invasive Beatmung, Substitution von Gerinnungsfaktoren, Gabe von Erythrozytenkonzentraten) erfasst. Abhängig von der Hauptursache für den Intensivaufenthalt wurden die Patienten prospektiv einer der folgenden Gruppen zugeordnet: Sepsis, respiratorische Insuffizienz, kardiovaskuläre Erkrankung, akutes Nierenversagen, Zustand nach Operation, Zustand nach CPR, gastrointestinale Erkrankung, sonstige Erkrankungen.

Ergebnisse und Diskussion

Es findet sich weder in der Gesamtkohorte noch in einer der prädefinierten Subgruppen eine Korrelation zwischen den Immunglobulinspiegeln bei Aufnahme und der Mortalität während des Aufenthaltes auf der Intensivstation. In einer logistischen Regression unter Berücksichtigung des Confounders APACHE-II-Score bei Aufnahme findet sich eine Korrelation zwischen erhöhten IgG-Spiegeln und geringerem Bedarf von invasiver Beatmung bei der Patientengruppe mit kardiovaskulären Erkrankungen. Andererseits besteht bei Patienten mit Sepsis ein Zusammenhang zwischen erhöhten IgM-Spiegeln und erhöhter Substitution von Gerinnungsfaktoren.

Schlussfolgerung

In unserer Studie kann kein Zusammenhang zwischen den Immunglobulinspiegeln im Serum und der ITS-Mortalität nachgewiesen werden.

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Abbreviations

ALI:

acute lung injury

ANOVA:

analysis of variance

APACHE score:

acute physiology and chronic health evaluation score

ARDS:

acute respiratory distress syndrome

ARF:

acute renal failure

BMI:

body mass index

CHD:

coronary heart disease

CPR:

state after cardiopulmonary resuscitation

CVD:

cardiovascular diseases

DIC:

disseminated intravascular coagulopathy

GI:

gastrointestinal diseases

ICU:

intensive care unit

Ig:

immunoglobulin

IgA:

immunoglobulin A

IgG:

immunoglobulin G

IgM:

immunoglobulin M

IVIg:

intravenous immunoglobulin

N:

number

NS:

non-surviving

O:

other diseases

OP:

postoperative condition

OR:

odds ratio

RF:

respiratory failure

RRT:

renal replacement therapy

S:

surviving

SE:

sepsis

SIRS:

systemic inflammatory response syndrome

Y:

years

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Authors and Affiliations

  1. Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany

    C. Geier, J. Schröder, A. Tamm, S. Dietz, S. Nuding, K. Holder, Ö. Khandanpour & K. Werdan

  2. Department of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097, Erfurt, Germany

    H. Ebelt MD

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  1. C. Geier
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  2. J. Schröder
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Correspondence to H. Ebelt MD.

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Conflict of interest

C. Geier, J. Schröder, A. Tamm, S. Dietz, S. Nuding, K. Holder, and Ö. Khandanpour state that there are no conflicts of interest.

H. Ebelt and K. Werdan have received funding for scientific projects and honoraria for lectures from Biotest AG. Ebelt and Werdan are members of the advisory board of the ongoing CIGMA trial sponsored by Biotest AG.

The study was conducted in accordance with the standards of the local ethics committee of the Martin Luther University Halle-Wittenberg.

Due to the study’s noninterventional design the need for patient consent was waived.

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Geier, C., Schröder, J., Tamm, A. et al. Influence of the serum levels of immunoglobulins on clinical outcomes in medical intensive-care patients. Med Klin Intensivmed Notfmed 112, 30–37 (2017). https://doi.org/10.1007/s00063-015-0121-0

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