Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shock

被引：19

作者：

Iizuka, Yusuke ^{[1
,2
]}

Sanui, Masamitsu ^{[1
]}

Sasabuchi, Yusuke ^{[3
]}

Lefor, Alan Kawarai ^{[4
]}

Hayakawa, Mineji ^{[5
]}

Saito, Shinjiro ^{[6
]}

Uchino, Shigehiko ^{[6
]}

Yamakawa, Kazuma ^{[7
]}

Kudo, Daisuke ^{[8
]}

Takimoto, Kohei ^{[9
,10
]}

Mayumi, Toshihiko ^{[11
]}

Azuhata, Takeo ^{[12
]}

Ito, Fumihito ^{[13
]}

Yoshihiro, Shodai ^{[14
]}

Hayakawa, Katsura ^{[15
]}

Nakashima, Tsuyoshi ^{[16
]}

Ogura, Takayuki ^{[17
,18
]}

Noda, Eiichiro ^{[19
]}

Nakamura, Yoshihiko ^{[20
]}

Sekine, Ryosuke ^{[21
]}

Yoshikawa, Yoshiaki ^{[7
]}

Sekino, Motohiro ^{[22
]}

Ueno, Keiko ^{[23
]}

Okuda, Yuko ^{[24
]}

Watanabe, Masayuki ^{[25
]}

Tampo, Akihito ^{[26
]}

Saito, Nobuyuki ^{[27
]}

Kitai, Yuya ^{[28
]}

Takahashi, Hiroki ^{[29
]}

Kobayashi, Iwao ^{[30
]}

Kondo, Yutaka ^{[31
]}

Matsunaga, Wataru ^{[1
]}

Nachi, Sho ^{[32
]}

Miike, Toru ^{[33
]}

Takahashi, Hiroshi ^{[34
]}

Takauji, Shuhei ^{[35
]}

Umakoshi, Kensuke ^{[36
]}

Todaka, Takafumi ^{[37
]}

Kodaira, Hiroshi ^{[38
]}

Andoh, Kohkichi ^{[39
]}

Kasai, Takehiko ^{[40
]}

Iwashita, Yoshiaki ^{[41
]}

Arai, Hideaki ^{[11
]}

Murata, Masato ^{[42
]}

Yamane, Masahiro ^{[43
]}

Shiga, Kazuhiro ^{[44
]}

Hori, Naoto ^{[45
]}

机构：

[1] Saitama Med Ctr, Jichi Med Univ, Dept Anesthesiol & Crit Care Med, 1-847 Amanuma, Omiya, Saitama 3308503, Japan

[2] Shonan Kamakura Gen Hosp, Dept Crit Care, Kamakura, Kanagawa, Japan

[3] Univ Tokyo, Sch Publ Hlth, Dept Clin Epidemiol & Hlth Econ, Tokyo, Japan

[4] Jichi Med Univ, Dept Surg, Shimotsuke, Tochigi, Japan

[5] Hokkaido Univ Hosp, Emergency & Crit Care Ctr, Sapporo, Hokkaido, Japan

[6] Jikei Univ, Sch Med, Dept Anesthesiol, Intens Care Unit, Tokyo, Japan

[7] Osaka Gen Med Ctr, Div Trauma & Surg Crit Care, Osaka, Japan

[8] Tohoku Univ, Grad Sch Med, Div Emergency & Crit Care Med, Sendai, Miyagi, Japan

[9] Osaka Univ, Grad Sch Med, Dept Anesthesiol & Intens Care Med, Suita, Osaka, Japan

[10] Kameda Med Ctr, Dept Intens Care Med, Kamogawa, Japan

[11] Univ Occupat & Environm Hlth, Dept Emergency Med, Kitakyushu, Fukuoka, Japan

[12] Nihon Univ, Sch Med, Dept Acute Med, Div Emergency & Crit Care Med, Tokyo, Japan

[13] Ohta Gen Hosp Fdn, Ohta Nishinouchi Hosp, Dept Emergency & Crit Care Med, Koriyama, Fukushima, Japan

[14] JA Hiroshima Gen Hosp, Dept Pharmaceut, Hiroshima, Japan

[15] Saitama Red Cross Hosp, Dept Emergency & Crit Care Med, Saitama, Japan

[16] Wakayama Med Univ, Dept Emergency & Crit Care Med, Wakayama, Japan

[17] Japan Red Cross Maebashi Hosp, Adv Med Emergency Dept, Dept Emergency Med & Crit Care Med, Maebashi, Gunma, Japan

[18] Japan Red Cross Maebashi Hosp, Crit Care Ctr, Maebashi, Gunma, Japan

[19] Kyushu Univ Hosp, Emergency & Crit Care Ctr, Fukuoka, Japan

[20] Fukuoka Univ, Fac Med, Dept Emergency & Crit Care Med, Fukuoka, Japan

[21] Ibaraki Cent Hosp, Emergency Dept, Kasama, Ibaraki, Japan

[22] Nagasaki Univ Hosp, Div Intens Care, Nagasaki, Japan

[23] Tokyo Med Univ, Hachioji Med Ctr, Dept Emergency & Crit Care Med, Tokyo, Japan

[24] Kyoto Daiichi Red Cross Hosp, Dept Emergency & Crit Care Med, Kyoto, Japan

[25] Saiseikai Yokohamasi Tobu Hosp, Intens Care Unit, Yokohama, Kanagawa, Japan

[26] Asahikawa Med Univ, Dept Emergency Med, Asahikawa, Hokkaido, Japan

[27] Chiba Hokusoh Hosp, Shock & Trauma Ctr, Nippon Med Sch, Inzai, Japan

[28] Kameda Med Ctr, Emergency Med, Kamogawa, Japan

[29] Osaka Univ, Grad Sch Med, Dept Traumatol & Acute Crit Med, Suita, Osaka, Japan

[30] Asahikawa Red Cross Hosp, Emergency & Crit Care Med, Asahikawa, Hokkaido, Japan

[31] Univ Ryukyus, Grad Sch Med, Dept Emergency & Crit Care Med, Nishihara, Okinawa, Japan

[32] Gifu Univ Hosp, Adv Crit Care Ctr, Gifu, Japan

[33] Saga Univ Hosp, Emergency & Crit Care Ctr, Saga, Japan

[34] Steel Mem Muroran Hosp, Div Cardiovasc Dis, Muroran, Hokkaido, Japan

[35] Sapporo City Gen Hosp, Dept Emergency Med & Crit Care, Sapporo, Hokkaido, Japan

[36] Ehime Univ Hosp, Div Emergency Med, Toon, Japan

[37] Tomishiro Cent Hosp, Intens Care Unit, Tomishiro, Japan

[38] Akashi City Hosp, Dept Emergency Med, Akashi, Hyogo, Japan

[39] Sendai City Hosp, Dept Emergency & Crit Care, Sendai, Miyagi, Japan

[40] Hakodate Municipal Hosp, Emergency Dept, Hakodate, Hokkaido, Japan

[41] Mie Univ Hosp, Emergency & Crit Care Ctr, Tsu, Mie, Japan

[42] Gunma Univ, Dept Emergency Med, Maebashi, Gunma, Japan

[43] KKR Sapporo Med Ctr, Dept Anesthesia & Intens Care, Sapporo, Hokkaido, Japan

[44] Seirei Mikatahara Gen Hosp, Emergency & Crit Care Ctr, Hamamatsu, Shizuoka, Japan

[45] Hyogo Coll Med, Intens Care Unit, Nishinomiya, Hyogo, Japan

来源：

CRITICAL CARE | 2017年 / 21卷

关键词：

Polyclonal intravenous immunoglobulin G; IVIG; Propensity score; Sepsis; Infection; Adjunctive therapy; INTRAVENOUS IMMUNOGLOBULIN; THERAPY;

D O I：

10.1186/s13054-017-1764-4

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: The administration of low-dose intravenous immunoglobulin G (IVIgG) (5 g/day for 3 days; approximate total 0.3 g/kg) is widely used as an adjunctive treatment for patients with sepsis in Japan, but its efficacy in the reduction of mortality has not been evaluated. We investigated whether the administration of low-dose IVIgG is associated with clinically important outcomes including intensive care unit (ICU) and in-hospital mortality. Methods: This is a post-hoc subgroup analysis of data from a retrospective cohort study, the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study. The JSEPTIC DIC study was conducted in 42 ICUs in 40 institutions throughout Japan, and it investigated associations between sepsis-related coagulopathy, anticoagulation therapies, and clinical outcomes of 3195 adult patients with sepsis and septic shock admitted to ICUs from January 2011 through December 2013. To investigate associations between low-dose IVIgG administration and mortalities, propensity score-based matching analysis was used. Results: IVIgG was administered to 960 patients (30.8%). Patients who received IVIgG were more severely ill than those who did not (Acute Physiology and Chronic Health Evaluation (APACHE) II score 24.2 +/- 8.8 vs 22.6 +/- 8.7, p < 0.001). They had higher ICU mortality (22.8% vs 17.4%, p < 0.001), but similar in-hospital mortality (34.4% vs 31.0%, p = 0.066). In propensity score-matched analysis, 653 pairs were created. Both ICU mortality and in-hospital mortality were similar between the two groups (21.0% vs 18.1%, p = 0.185, and 32.9% vs 28.6%, p = 0.093, respectively) using generalized estimating equations fitted with logistic regression models adjusted for other therapeutic interventions. The administration of IVIgG was not associated with ICU or in-hospital mortality (odds ratio (OR) 0.883; 95% confidence interval (CI) 0.655-1.192, p = 0.417, and OR 0.957, 95% CI, 0.724-1.265, p = 0.758, respectively). Conclusions: In this analysis of a large cohort of patients with sepsis and septic shock, the administration of low-dose IVIgG as an adjunctive therapy was not associated with a decrease in ICU or in-hospital mortality. Trial registration: University Hospital Medical Information Network Individual Clinical Trials Registry, UMINCTR000012543. Registered on 10 December 2013.

引用

页数：9

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