Comparative study between intravenous immunoglobulins and standard treatment in septic patients

Introduction

The use of intravenous immunoglobulins (IVIG) in the treatment of human sepsis remains controversial. The aim of this study was to assess the effects of IVIG in patients with severe sepsis with or without septic shock on mortality and morbidity compared with standard treatment of sepsis.

Methods

This prospective controlled study included 32 patients randomized according to the type of sepsis treatment into: 16 patients with standard treatment of sepsis plus IVIG, and 16 patients with standard treatment of sepsis as controls. IgM-enriched IVIG was given at a dose of 5 ml/kg/day for three consecutive days. APACHE II and SOFA scores were calculated on days 1 and 4 and then day 14. Recording of any side-effect related to IVIG therapy was done to test the drug tolerability. Serial levels of serum TNFα, IL-1, IL-6, L-10 and serum CD14 were measured daily.

Results

Compared with conventional treatment of sepsis, IVIG reduced APACHE II and SOFA scores significantly on day 14 of hospitalization. The serum procalcitonin (PCT) level showed a significantly consistent decline from day 1 to day 14 in IVIG-treated patients of the entire group as well as the severe sepsis and septic shock subgroups. The PCT level always showed a rise in conventionally treated patients from day 1 to day 14 in the entire group and severe sepsis and septic shock subgroups. Significant decline in the serial CD14 and IL-I levels from day 1 to day 5 occurred in the IVIG-treated entire group of patients as well as the severe sepsis and septic shock subgroups of patients. The mortality rate was significantly lower in IVIG-treated patients with severe sepsis compared with conventionally treated patients (40% vs 70%). In IVIG-treated patients with septic shock, the mortality rate was 100% just like that of the conventionally treated patients with septic shock.

Conclusion

Used early enough, IVIG therapy induces substantial improvement in morbidity and mortality in patients with severe sepsis, but could not demonstrate any beneficial effect on the morbidity or mortality rate in patients with septic shock. The improvement in the clinical course and ultimate outcome of severe sepsis is paralleled by a consistent decline in serum levels of IL-6, PCT and CD14.