The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure

Ignacio Martin-Loeches, Arturo Muriel-Bombín, Ricard Ferrer, Antonio Artigas, Jordi Sole-Violan, Leonardo Lorente, David Andaluz-Ojeda, Adriele Prina-Mello, Ruben Herrán-Monge, Borja Suberviola, Ana Rodriguez-Fernandez, Pedro Merino, Ana M. Loza, Pablo Garcia-Olivares, Eduardo Anton, Eduardo Tamayo, Wysali Trapiello, Jesús Blanco, Jesús F. Bermejo-Martin, Marta María García-GarcíaMª Jesús López Pueyo, Jose Antonio Fernandez Ratero, Miguel Martinez Barrios, Fernando Callejo Torre, Sergio Ossa Echeverri, Demetrio Carriedo Ule, Ana Mª Domínguez Berrot, Fco Javier Díaz Domínguez, Susana Moradillo, Braulio Alvarez Martínez, Noelia Albalá, Juan Carlos Ballesteros, Marta Paz Perez, Elena Perez Losada, Santiago Macías, Rafael Pajares García, Noelia Recio García Cervigón, Mª Mar Gobernado Serrano, Mª José Fernández Calavia, Daniel Moreno Torres, Concha Tarancón, Teresa Loreto, Priscila Carcelen, Rafael Cítores y.Francisco Gandía

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21 Citations (Scopus)


© 2017, The Author(s). Background: Pre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity. Methods: This was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score at ICU admission (SOFA < 8, n = 122 and SOFA ≥ 8, n = 156), and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by Kaplan–Meier and multivariate logistic regression analysis. Results: ICU/hospital mortality in the SOFA < 8 group was 14.8/23.0%, compared to 30.1/35.3% in the SOFA ≥ 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG < 407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated with a reduction in the survival mean time of 6.6 days in the first 28 days and was a robust predictor of mortality risk either during the acute or during the post-acute phase of the disease (OR for ICU mortality: 13.79; OR for hospital mortality: 7.98). This predictive ability remained in the absence of prior immunosuppression (OR for ICU mortality: 17.53; OR for hospital mortality: 5.63). Total IgG < 407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA ≥ 8 group, we found no immunoglobulin thresholds associated with neither ICU nor hospital mortality. Conclusions: Endogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortalities.
Original languageEnglish
Article number44
JournalAnnals of intensive care
Issue number1
Publication statusPublished - 1 Dec 2017


  • Immunoglobulins
  • Sepsis
  • Severity
  • Survival


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