Background factors in patients receiving immunoglobulin administration and changes in sepsis markers

Introduction

The potentially envisaged actions of intravenous immunoglobulin (IVIg) on severe infectious disease include virus or toxin neutralizing action, opsonic effect, complement bacteriolytic activity, and enhancement of sensitivity to antibiotics. In the case of severe infectious disease, antibiotics are often supplemented with administration of IVIg. The aim of this study is that the changes in sepsis markers followed by IVIg administration are investigated with severe sepsis or severe septic shock patients.

Methods

The subjects were 52 patients admitted to an ICU with a diagnosis of severe sepsis or septic shock and from whom informed consent had been obtained for the present study. IVIg was administered intravenously for 3 days (5.0 g/day) and measurements were undertaken before administration (Day 1), on the day after completion of administration (Day 4), and on Day 7. The items measured were IL-6, C-reactive protein (CRP) and, as indices of vascular endothelial cell activation, plasminogen activator inhibitor-1 (PAI-1) and adhesion molecules (endothelial leukocyte adhesion molecule-1 (ELAM-1)); the effect of IVIg administration on these markers was then studied. The IVIg studied was polyethylene glycol-treated human immunoglobulin injection fluid (2.5 g, 50 ml, one vial).

Results

The APACHE II score was 25.3 ± 7.8, the SOFA score 9.5 ± 3.5, and the survival rate after 28 days 76.9%. The values before IVIg administration were: procalcitonin 28.8 ± 44.5 (median value 13.6) ng/ml, CRP 16.3 ± 8.3 (median value 16.0) mg/dl, IL-6 8,873 ± 19,362 (median value 744) pg/ml, PAI-1 374 ± 428 (median value 178) ng/ml, and ELAM-1 198 ± 359 (median value 61) ng/ml. All values were thus elevated. After the completion of IVIg administration, the level of mediators other than ELAM-1 (procalcitonin, CRP, IL-6, PAI-1) decreased significantly.

Conclusions

The results of the present study found significant decreases of IL-6 and PAI-1 resulting from immunoglobulin administration, but did not indicate a protective effect on vascular endothelial cell function.