IgMA-enriched immunoglobulin in neutropenic patients with sepsis syndrome and septic shock: A randomized, controlled, multiple-center trial *.
Hentrich, Marcus MD; Fehnle, Karl PhD; Ostermann, Helmut MD; Kienast, Joachim MD; Cornely, Oliver MD; Salat, Christoph MD; Ubelacker, Ralf MD; Buchheidt, Dieter MD; Behre, Gerhard MD; Hiddemann, Wolfgang MD; Schiel, Xaver MD
Critical Care Medicine.
34(5):1319-1325, May 2006.
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Objective: To evaluate the effect of intravenous IgMA-enriched immunoglobulin (ivIGMA) therapy on mortality in neutropenic patients with hematologic malignancies and sepsis syndrome or septic shock.
Design: Multiple-center, prospective randomized, controlled study.
Setting: Six university hospitals in Germany.
Patients: Patients were 211 neutropenic patients with sepsis syndrome or septic shock after chemotherapy for severe hematologic disorders between 1992 and 1999.
Interventions: Patients received 1300 mL of ivIGMA (7.8 g IgM, 7.8 g IgA, and 49.4 g IgG) infused intravenously within a period of 72 hrs or human albumin according to the same schedule as ivIGMA.
Measurements and Main Results: All-cause mortality at 28 days, sepsis-related mortality at 28 days, all-cause mortality at 60 days, mortality from septic shock, and mortality from microbiologically proven Gram-negative sepsis and septic shock were recorded. Immunoglobulin had no benefit over human albumin. The 28-day mortality rate was 26.2% and 28.2% in the ivIGMA and control patients, respectively (difference, 2.0% [95% confidence interval, -10.2 to 14.2 percentage points]). Likewise, the 60-day mortality rate did not differ between both arms (29.6% vs. 34.7% in the ivIGMA and control patients, respectively). Mortality rates in patients with sepsis syndrome (17.1% vs. 16.7%) and septic shock (51.9% vs. 54.8%) were also found to be similar between both groups.
Conclusions: Intravenous ivIGMA had no beneficial effects in neutropenic patients with hematologic malignancies and sepsis syndrome and septic shock.
(C) 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins