Effect of the Immunoglobulin G-A-M Treatment on Hepatic Functions and Mortality rates in Patients with Septic Shock

Background: In this study, we aimed to explore the effects of conventional sepsis treatment, including classical antibiotherapy and Immunoglubin (Ig) G-A-M combination (Pentaglobin®), on liver function tests and mortality rate in patients with septic shock. Methods: All patients diagnosed with septic shock and treated with Pentaglobin® in the adult intensive care unit of Suleyman Demirel University Practice and Research Hospital between 2005-2013 were retrospectively examined. Demographic properties, age, gender, intensive care treatment duration, general exitus day, the death rate in the first 28 days, general death-survival period, 28th-day death rate, mortality rate, and diagnosis of cases were recorded. Results: At the end of the treatment, it was found that 35 of the cases died, and 35 were transferred to various clinical wards. The overall mortality rate was calculated as 50% from the obtained data. It was found that 40 patients survived in the first 28 dayswhile 30 patients died. In this study, it was observed that Pentaglobin® treatment had no statistically significant impact on ASTALT-Albumin values and mortality rates. Conclusions: However, early diagnosis of sepsis, early initiation of antibiothearpy, early source control, and timely initiation of appropriate fluid therapy play a key role in the succsess of sepsis treatment. For this purpose, as emphasized in the sepsis 3 guideline, we think that raising awareness by physicians and practitioners in the early diagnosis of sepsis is the most important step in the treatment of this clinical condition.

Keywords:

Sepsis Liver Function Tests, Immunoglobulin G-A-M.,

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1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
2. Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Med. 2019;7:2050312119835043.
3. Bugiantella W, Rondelli F, Boni M, Stella P, Polistena A, Sanguinetti A, et al. Necrotizing pancreatitis: A review of the interventions. Int J Surg. 2016;28 Suppl 1:S163-71.
4. Eastridge BJ, Holcomb JB, Shackelford S. Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury. Transfusion. 2019;59(S2):1423-1428.
5. van Breugel JMM, Niemeyer MJS, Houwert RM, Groenwold RHH, Leenen LPH, van Wessem KJP. Global changes in mortality rates in polytrauma patients admitted to the ICU-a systematic review. World J Emerg Surg. 2020;15(1):55.
6. Webb JG, Sanborn TA, Sleeper LA, Carere RG, Buller CE, Slater JN, et al. SHOCK Investigators. Percutaneous coronary intervention for cardiogenic shock in the SHOCK Trial Registry. Am Heart J. 2001;141(6):964-70.
7. Rodríguez-Acelas AL, de Abreu Almeida M, Engelman B, Cañon- Montañez W. Risk factors for health care-associated infection in hospitalized adults: Systematic review and meta-analysis. Am J Infect Control. 2017;45(12):e149-e156.
8. SepNet Critical Care Trials Group. Incidence of severe sepsis and septicshock in German intensive care units: the prospective, multicentre INSEP study. Intensive Care Med. 2016;42(12):1980-1989.
9. Karlsson S, Varpula M, Ruokonen E, Pettilä V, Parviainen I, Ala-KokkoTI, et al. Incidence, treatment, and outcome of severe sepsis in ICUtreated adults in Finland: the Finnsepsis study. Intensive Care Med. 2007;33(3):435-43.
10. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311(13):1308-16.
11. Baykara N, Akalin H, Arslantas MK, Hanci V, Caglayan C, Kahveci F, et al. Sepsis Study Group. Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study. Crit Care. 2018 Apr 16;22(1):93.
12. RodrÃguez A, Rello J, Neira J, Maskin B, Ceraso D, Vasta L, et al. Effects of high-dose of intravenous immunoglobulin and antibiotics on survival for severe sepsis undergoing surgery. Shock. 2005;23(4):298-304.
13. Basyreva LY, Brodsky IB, Gusev AA, Zhapparova ON, Mikhalchik EV, Gusev SA, et al. The effect of Intravenous Immunoglobulin (IVIG) on \textit{ex vivo} activation of human leukocytes. Hum Antibodies. 2016;24(3-4):39-44.
14. Kaveri SV. Mechanisms of action of intravenous immunoglobulins. Bull Acad Natl Med. 2012;196(1):39-47; discussion 47-8. French.
15. Nakae T, Tanaka J, Nakano A, Ono Y. Complement-mediated bactericidal effect of antibodies in human intravenous preparation against multi-drug resistant pseudomonas aeruginosa. Jpn J Antibiot. 2008;61(6):379-87..
16. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-377.
17. Hattori Y, Takano K, Teramae H, Yamamoto S, Yokoo H, Matsuda N. Insights into sepsis therapeutic design based on the apoptotic death pathway. J Pharmacol Sci. 2010;114(4):354-65.
18. McCuskey RS, Nishida J, McDonnell D, Baker GL, Urbaschek R, Urbaschek B. Effect of immunoglobulin G on the hepatic microvascular inflammatory response during sepsis. Shock. 1996;5(1):28-33.
19. Shmygalev S, Damm M, Knels L, Strassburg A, WÃ¼nsche K, Dumke R, et al. IgM-enriched solution BT086 improves host defense capacity and energy store preservation in a rabbit model of endotoxemia. Acta Anaesthesiol Scand. 2016;60(4):502-12.
20. Alejandria MM, Lansang MA, Dans LF, Mantaring JB 3rd. Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock. Cochrane Database Syst Rev. 2013;2013(9):CD001090.
21. Kreymann KG, de Heer G, Nierhaus A, Kluge S. Use of polyclonal immunoglobulins as adjunctive therapy for sepsis or septic shock. Crit Care Med. 2007;35(12):2677-85.
22. Pilz G, Kreuzer E, Kääb S, Appel R, Werdan K. Early sepsis treatment with immunoglobulins after cardiac surgery in score-identified highrisk patients. Chest. 1994;105(1):76-82.
23. Reith HB, Rauchschwalbe SK, MittelkÃ¶tter U, Engemann R, Thiede A, Arnold A, et al. IgM-enriched immunoglobulin (pentaglobin) positively influences the course of post-surgical intra-abdominal infections. Eur J Med Res. 2004;9(10):479-84.
24. Ozcan PE, Senturk E, Orhun G, Gumru S, Arican N, Orhan N, et al. Effects of intravenous immunoglobulin therapy on behavior deficits and functions in sepsis model. Ann Intensive Care. 2015;5(1):62.
25. Aubron C, Berteau F, Sparrow RL. Intravenous immunoglobulin for adjunctive treatment of severe infections in ICUs. Curr Opin Crit Care. 2019;25(5):417-422.
26. Hoffman JN, Fertmann JM, Vollmar B, Laschke MW, Jauch KW, Menger MD. Immunoglobulin M-enriched human intravenous immunoglobulins reduce leukocyte-endothelial cell interactions and attenuate microvascular perfusion failure in normotensive endotoxemia. Shock. 2008;29(1):133-9.
27. Domizi R, Adrario E, Damiani E, Scorcella C, Carsetti A, Giaccaglia P, et al. IgM-enriched immunoglobulins (Pentaglobin) may improve the microcirculation in sepsis: a pilot randomized trial. Ann Intensive Care. 2019;9(1):135.
28. Cui J, Wei X, Lv H, Li Y, Li P, Chen Z, et al. The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysis. Ann Intensive Care. 2019;9(1):27.
29. Tagami T, Matsui H, Fushimi K, Yasunaga H. Intravenous immunoglobulin use in septic shock patients after emergency laparotomy. J Infect. 2015;71(2):158-66.
30. Tagami T, Matsui H, Fushimi K, Yasunaga H. Intravenous immunoglobulin and mortality in pneumonia patients with septic shock: an observational nationwide study. Clin Infect Dis. 2015;61(3):385-92.
31. Kadri SS, Swihart BJ, Bonne SL, Hohmann SF, Hennessy LV, Louras P, et al. Impact of Intravenous Immunoglobulin on Survival in Necrotizing Fasciitis With Vasopressor-Dependent Shock: A Propensity Score-Matched Analysis From 130 US Hospitals. Clin Infect Dis. 2017;64(7):877-885.
32. Gürü S, Kadı G, Öktem B, Karamercan MA. Carboxyhemoglobin, methemoglobin and lactate levels in patients with systemic inflammatory response syndrome. Arch Curr Med Res. 2021;2(2):80-87