Selection of Ig Preparations and Ig Serum Levels
The IgG preparation was chosen for its high antibody titers against Gram-positive bacterial toxins and its effectiveness against these pathogens in experimental animals, given the preponderance of these microorganisms as infective agents after heart surgery. The IgGMA preparation was selected for its reported antibody titer, particularly including IgM, against endotoxic determinants of the core polysaccharide, since endotoxemia is known to occur in the early postoperative course after extracorporeal circulation.
Our study confirms the ability of supplemental Ig administration to significantly increase serum IgG levels in patients with sepsis. The data from our IgG therapy group favor the assumption of an association between higher posttreatment IgG levels and a beneficial outcome and thus the concept of a deficient immunoprotein synthesis and/or abnormal IgG consumption in patients with severe infections. These clinical results are consistent with a decreased Ig production in culture of Ig synthesizing and secreting cells from patients after cardiac surgery. A surprising yet unexplained finding in the IgGMA group was the tendency toward higher IgM levels in the nonresponders. buy birth control
Classically, Ig effectiveness in sepsis has been attributed to the antitoxic and opsonic activity of the antibodies administered or their synergism with £-lactam antibiotics. Recent data have provided further insight into possible mechanisms of Ig action. Thus, there is in vitro evidence for modulation of monokine production by Ig, such as down-regulation of interleukin 6 synthesis. Preliminary results in patients with sepsis further indicate that Ig treatment may correct the abnormally high skeletal muscle Po2 and thus possibly improve the impaired peripheral oxygen utilization.
Given the good comparability of treatment and historical control groups, our results show that early supplemental IgG or IgGMA sepsis treatment improves disease severity and may improve prognosis in prospectively APACHE II score-identified high-risk patients after cardiac surgery. The trial documents the usefulness of an early postoperative risk assessment using the practicable APACHE II score with the intention to treat.