IgG2 as an independent risk factor for mortality in patients with community-acquired pneumonia

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• 作者：Mari C. de la Torre^a ; ^{mctorre@csdm.cat" class="auth_mail" title="E-mail the corresponding author} ; ^{maridelat@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Elisabet Palomera^b ; ^{epalomera@csdm.cat" class="auth_mail" title="E-mail the corresponding author} ; Mateu Serra-Prat^b ; ^{mserra@csdm.cat" class="auth_mail" title="E-mail the corresponding author} ; Estel Gü ; ell^a ; ^{eguell@csdm.cat" class="auth_mail" title="E-mail the corresponding author} ; Joan Carles Yé ; benes^a ; ^{jyebenes@csdm.cat" class="auth_mail" title="E-mail the corresponding author} ; Jesú ; s F. Bermejo-Martí ; n^c ; ¹ ; ^{jfbermejo@saludcastillayleon.es" class="auth_mail" title="E-mail the corresponding author} ; Jordi Almirall^a ; ^d ; ^e ; ¹ ; ^{jalmirall@csdm.cat" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Immunoglobulin ; Community acquired pneumonia ; Mortality ; IgG2 ; Prognosis ; Intensive care unit
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：35
• 期：Complete
• 页码：115-119
• 全文大小：267 K

文摘

Mortality in patients with community-acquired pneumonia (CAP) remains high despite improvements in treatment.

Objective

To determine immunoglobulin levels in patients with CAP and impact on disease severity and mortality.

Methodology

Observational study. Hospitalized patients with CAP were followed up for 30 days. Levels of immunoglobulin G (IgG) and subclasses, immunoglobulin A (IgA) and immunoglobulin M (IgM) were measured in serum within 24 hours of CAP diagnosis.

Results

Three hundred sixty-two patients with CAP were enrolled − 172 ward-treated and 190 intensive care unit-treated. Intensive care unit–treated patients had significantly lower values of IgG1, IgG2, IgG3 subclasses, and IgA than ward-treated patients. Thirty-eight patients died before 30 days. Levels of IgG2 were significantly lower in non-survivors than survivors (P = .004) and IgG2 < 301 mg/dL was associated with poorer survival according to both the bivariate (hazard ratio 4.47; P < .001) and multivariate (HR 3.48; P = .003) analyses.

Conclusions

Patients with CAP with IgG2 levels < 301 mg/dL had a poorer prognosis and a higher risk of death. Our study suggests the usefulness of IgG2 to predict CAP evolution and to provide support measures or additional treatment.