Beneficial role of endogenous immunoglobulin subclasses and isotypes in septic shock

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• 作者：Eduardo Tamayo ; MD ; PhD^a ; ^b ; ¹ ; Ana Ferná ; ndez ; MD^a ; ^b ; ¹ ; Raquel Almansa ; PhD^b ; ^c ; ¹ ; Elena Carrasco ; MD^a ; ^b ; Lisbeth Goncalves ; MD^b ; Marí ; a Heredia ; MD^a ; ^b ; David Andaluz-Ojeda ; MD^b ; ^d ; Gabriel March ; MSc^b ; Lucia Rico ; MLT^b ; ^c ; Jose I. Gó ; mez-Herreras ; MD PhD^a ; ^b ; Raú ; l Ortiz de Lejarazu ; MD PhD^b ; ^c ; Jesus F. Bermejo-Martin ; MD PhD^b ; ^c ; ^{jfbermejo@saludcastillayleon.es}
• 关键词：Endogenous ; Immunoglobulin ; Isotype ; Subclass ; Sepsis
• 刊名：Journal of Critical Care
• 出版年：2012
• 出版时间：December, 2012
• 年：2012
• 卷：27
• 期：6
• 页码：616-622
• 全文大小：288 K

文摘

Purpose

There is increasing evidence on the relationship between endogenously produced immunoglobulins and the clinical outcome in septic shock (SS).

Materials and methods

Levels of immunoglobulin G (IgG) subclasses, immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin E were measured in plasma from 42 patients with SS and in 36 patients with systemic inflammatory response syndrome at diagnosis. Association of immunoglobulins levels with disease severity and outcome was evaluated.

Results

Eighteen patients with SS finally died. Both patients with systemic inflammatory response syndrome and SS showed subnormal levels of total IgG, IgG2, and IgM. Patients with SS who died showed the lowest levels of total IgG and IgG1. Total IgG, IgG1, IgG2, IgG3, IgG4, and IgA correlated inversely with Acute Physiology and Chronic Health Evaluation II score in SS. Univariate Cox regression analysis showed that levels of IgG1, IgG2, IgG3, IgM, IgA, and total IgG were inversely associated to the probability of death at 28 days. Multivariate analysis showed that IgG1, total IgG, IgM, and IgA behaved as independent protective factors against mortality (hazard ratio, P): 0.23, 0.026; 0.16, 0.028; 0.11, 0.042; 0.05, 0.010, respectively, whereas IgG3 showed a protective trend also.

Conclusions

Our study evidenced that, in addition to IgG1, other major endogenous immunoglobulins isotypes and subclasses seem to play a beneficial role in SS.