Beneficial role of endogenous immunoglobulin subclasses and isotypes in septic shock

• Published in: Journal of critical care 2012-12, Vol.27 (6), p.616-622
• Main Authors: Tamayo, Eduardo, MD, PhD, Fernández, Ana, MD, Almansa, Raquel, PhD, Carrasco, Elena, MD, Goncalves, Lisbeth, MD, Heredia, María, MD, Andaluz-Ojeda, David, MD, March, Gabriel, MSc, Rico, Lucia, MLT, Gómez-Herreras, Jose I., MD PhD, de Lejarazu, Raúl Ortiz, MD PhD, Bermejo-Martin, Jesus F., MD PhD
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal surgery; Aged; Aged, 80 and over; Chronic obstructive pulmonary disease; Comorbidity; Confidence intervals; Critical Care; Disease; Endogenous; Female; Hospitals; Humans; Immunoglobulin; Immunoglobulin A - classification; Immunoglobulin A - metabolism; Immunoglobulin E - classification; Immunoglobulin E - metabolism; Immunoglobulin G - classification; Immunoglobulin G - metabolism; Immunoglobulin Isotypes - classification; Immunoglobulin Isotypes - metabolism; Immunoglobulin M - classification; Immunoglobulin M - metabolism; Immunoglobulins; Isotype; Male; Middle Aged; Mortality; Multivariate analysis; Plasma; Regression analysis; Respiratory distress syndrome; Sepsis; Shock, Septic - immunology; Shock, Septic - mortality; Studies; Subclass; Surgery; Systemic Inflammatory Response Syndrome - immunology; Systemic Inflammatory Response Syndrome - mortality; Values; Variables; Ventilation
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2012.08.004

Abstract Purpose There is increasing evidence on the relationship between endogenously produced immunoglobulins and the clinical outcome in septic shock (SS). Materials and methods Levels of immunoglobulin G (IgG) subclasses, immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin E were measured in plasma from 42 patients with SS and in 36 patients with systemic inflammatory response syndrome at diagnosis. Association of immunoglobulins levels with disease severity and outcome was evaluated. Results Eighteen patients with SS finally died. Both patients with systemic inflammatory response syndrome and SS showed subnormal levels of total IgG, IgG2, and IgM. Patients with SS who died showed the lowest levels of total IgG and IgG1. Total IgG, IgG1, IgG2, IgG3, IgG4, and IgA correlated inversely with Acute Physiology and Chronic Health Evaluation II score in SS. Univariate Cox regression analysis showed that levels of IgG1, IgG2, IgG3, IgM, IgA, and total IgG were inversely associated to the probability of death at 28 days. Multivariate analysis showed that IgG1, total IgG, IgM, and IgA behaved as independent protective factors against mortality (hazard ratio, P ): 0.23, 0.026; 0.16, 0.028; 0.11, 0.042; 0.05, 0.010, respectively, whereas IgG3 showed a protective trend also. Conclusions Our study evidenced that, in addition to IgG1, other major endogenous immunoglobulins isotypes and subclasses seem to play a beneficial role in SS.