Critical Care (Jul 2017)
Low-dose immunoglobulin G is not associated with mortality in patients with sepsis and septic shock
- Yusuke Iizuka,
- Masamitsu Sanui,
- Yusuke Sasabuchi,
- Alan Kawarai Lefor,
- Mineji Hayakawa,
- Shinjiro Saito,
- Shigehiko Uchino,
- Kazuma Yamakawa,
- Daisuke Kudo,
- Kohei Takimoto,
- Toshihiko Mayumi,
- Takeo Azuhata,
- Fumihito Ito,
- Shodai Yoshihiro,
- Katsura Hayakawa,
- Tsuyoshi Nakashima,
- Takayuki Ogura,
- Eiichiro Noda,
- Yoshihiko Nakamura,
- Ryosuke Sekine,
- Yoshiaki Yoshikawa,
- Motohiro Sekino,
- Keiko Ueno,
- Yuko Okuda,
- Masayuki Watanabe,
- Akihito Tampo,
- Nobuyuki Saito,
- Yuya Kitai,
- Hiroki Takahashi,
- Iwao Kobayashi,
- Yutaka Kondo,
- Wataru Matsunaga,
- Sho Nachi,
- Toru Miike,
- Hiroshi Takahashi,
- Shuhei Takauji,
- Kensuke Umakoshi,
- Takafumi Todaka,
- Hiroshi Kodaira,
- Kohkichi Andoh,
- Takehiko Kasai,
- Yoshiaki Iwashita,
- Hideaki Arai,
- Masato Murata,
- Masahiro Yamane,
- Kazuhiro Shiga,
- Naoto Hori
Affiliations
- Yusuke Iizuka
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center
- Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center
- Yusuke Sasabuchi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo
- Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University
- Mineji Hayakawa
- Emergency and Critical Care Center, Hokkaido University Hospital
- Shinjiro Saito
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine
- Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine
- Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center
- Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine
- Kohei Takimoto
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine
- Toshihiko Mayumi
- Department of Emergency Medicine, University of Occupational and Environmental Health
- Takeo Azuhata
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine
- Fumihito Ito
- Department of Emergency and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital
- Shodai Yoshihiro
- Pharmaceutical Department, JA Hiroshima General Hospital
- Katsura Hayakawa
- Department of Emergency and Critical Care Medicine, Saitama Red Cross Hospital
- Tsuyoshi Nakashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University
- Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital
- Eiichiro Noda
- Emergency and Critical Care Center, Kyushu University Hospital
- Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University
- Ryosuke Sekine
- Emergency Department, Ibaraki Prefectural Central Hospital
- Yoshiaki Yoshikawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center
- Motohiro Sekino
- Division of Intensive Care, Nagasaki University Hospital
- Keiko Ueno
- Department of Emergency and Critical Care Medicine, Tokyo Medical University, Hachioji Medical Center
- Yuko Okuda
- Department of Emergency and Critical Care Medicine, Kyoto Daiichi Red-Cross Hospital
- Masayuki Watanabe
- Intensive Care Unit, Saiseikai Yokohamasi Tobu Hospital
- Akihito Tampo
- Department of Emergency Medicine, Asahikawa Medical University
- Nobuyuki Saito
- Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital
- Yuya Kitai
- Emergency Medicine, Kameda Medical Center
- Hiroki Takahashi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
- Iwao Kobayashi
- Emergency and Critical Care Medicine, Asahikawa Red Cross Hospital
- Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyu
- Wataru Matsunaga
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center
- Sho Nachi
- Advanced Critical Care Center, Gifu University Hospital
- Toru Miike
- Emergency and Critical Care Center, Saga University Hospital
- Hiroshi Takahashi
- The Division of Cardiovascular Disease, Steel Memorial Muroran Hospital
- Shuhei Takauji
- Department of Emergency Medicine and Critical Care, Sapporo City General Hospital
- Kensuke Umakoshi
- Division of Emergency Medicine, Ehime University Hospital
- Takafumi Todaka
- Intensive Care Unit, Tomishiro Central Hospital
- Hiroshi Kodaira
- Department of Emergency Medicine, Akashi City Hospital
- Kohkichi Andoh
- Department of Emergency and Critical Care, Sendai City Hospital
- Takehiko Kasai
- Emergency Department, Hakodate Municipal Hospital
- Yoshiaki Iwashita
- Emergency and Critical Care Center, Mie University Hospital
- Hideaki Arai
- Department of Emergency Medicine, University of Occupational and Environmental Health
- Masato Murata
- Department of Emergency Medicine, Gunma University
- Masahiro Yamane
- Department of Anesthesia and Intensive Care, KKR Sapporo Medical Center
- Kazuhiro Shiga
- Emergency and Critical Care Center, Seirei Mikatahara General Hospital
- Naoto Hori
- Intensive Care Unit, Hyogo College of Medicine
- DOI
- https://doi.org/10.1186/s13054-017-1764-4
- Journal volume & issue
-
Vol. 21,
no. 1
pp. 1 – 9
Abstract
Abstract Background The administration of low-dose intravenous immunoglobulin G (IVIgG) (5 g/day for 3 days; approximate total 0.3 g/kg) is widely used as an adjunctive treatment for patients with sepsis in Japan, but its efficacy in the reduction of mortality has not been evaluated. We investigated whether the administration of low-dose IVIgG is associated with clinically important outcomes including intensive care unit (ICU) and in-hospital mortality. Methods This is a post-hoc subgroup analysis of data from a retrospective cohort study, the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study. The JSEPTIC DIC study was conducted in 42 ICUs in 40 institutions throughout Japan, and it investigated associations between sepsis-related coagulopathy, anticoagulation therapies, and clinical outcomes of 3195 adult patients with sepsis and septic shock admitted to ICUs from January 2011 through December 2013. To investigate associations between low-dose IVIgG administration and mortalities, propensity score-based matching analysis was used. Results IVIgG was administered to 960 patients (30.8%). Patients who received IVIgG were more severely ill than those who did not (Acute Physiology and Chronic Health Evaluation (APACHE) II score 24.2 ± 8.8 vs 22.6 ± 8.7, p < 0.001). They had higher ICU mortality (22.8% vs 17.4%, p < 0.001), but similar in-hospital mortality (34.4% vs 31.0%, p = 0.066). In propensity score-matched analysis, 653 pairs were created. Both ICU mortality and in-hospital mortality were similar between the two groups (21.0% vs 18.1%, p = 0.185, and 32.9% vs 28.6%, p = 0.093, respectively) using generalized estimating equations fitted with logistic regression models adjusted for other therapeutic interventions. The administration of IVIgG was not associated with ICU or in-hospital mortality (odds ratio (OR) 0.883; 95% confidence interval (CI) 0.655–1.192, p = 0.417, and OR 0.957, 95% CI, 0.724–1.265, p = 0.758, respectively). Conclusions In this analysis of a large cohort of patients with sepsis and septic shock, the administration of low-dose IVIgG as an adjunctive therapy was not associated with a decrease in ICU or in-hospital mortality. Trial registration University Hospital Medical Information Network Individual Clinical Trials Registry, UMIN-CTR000012543 . Registered on 10 December 2013.
Keywords
