Levels of soluble fibrin in severe septic patients given intravenous immunoglobulin

Introduction

It is known that severe sepsis causes multiple organ failure and high mortality. Intravenous immunoglobulin (IVIG) is used for severe sepsis patients. The mechanism of IVIG is clearly unknown. Suggested, however, is the possibility that IVIG prevents organic injury by suppressing the inflammation. Soluble fibrin (SF) is intermediate between fibrinogen and fibrionoligomer. It is better than fibrinogen as the material for thrombin. IVIG is used as one of the effective factors for repair of the damaged vascular endothelium. In this study we used SF as a marker of severity of illness in patients with or without IVIG and compared the levels of SF in two groups.

Methods

Nineteen severe septic patients were divided into two groups. The control group (n = 9) was not given and the other group (n = 10) was given IVIG (5 g/day for 3 days). SF of serum from patients was measured on 0 days, 1 day, 3 days, 5 days and 7 days, and the results were analyzed.

Results

The levels of SF were: control group: 4.77 ± 9.44 (0 days), 3.13 ± 2.53 (1 day), 3.33 ± 2.75 (3 days), 2.53 ± 2.58 (5 days), 2.58 ± 3.75 (7 days); other group: 7.71 ± 8.28 (0 days), 12.26 ± 16.75 (1 day), 14.34 ± 25.56 (3 days), 8.06 ± 9.08 (5 days), 11.95 ± 12.71 (7 days). There was a significant difference in the levels of SF between groups with and without IVIG at 1 day, 5 days and 7 days.

Conclusion

Monocyte has the Fcγ receptor. It is thought that stimulating Fcγ of monocyte with IgG plays a role in increasing SF. Without severe DIC, increasing fibrin is used in the repair of the damaged vascular endothelium as a matrix and it prevents the invasion of germs. It is thought that increasing fibrin is the appropriate stimulation for coagulation and one of the reactions of biomechanical defense. We think SF is one of the important factors for the damaged cell and a useful marker of severity for severe sepsis. We also think IVIG is effective for severe sepsis.