Chest, Vol 105, 76-82, Copyright © 1994 by American College of Chest Physicians

ARTICLES

Early sepsis treatment with immunoglobulins after cardiac surgery in score-identified high-risk patients [published erratum appears in Chest 1994 Jun;105(6):1924]

G Pilz, E Kreuzer, S Kaab, R Appel and K Werdan
Department of Medicine I, Grosshadern University Hospital, University of Munich, Germany.

In patients at risk for sepsis after cardiac surgery, the efficacy of intravenous immunoglobulin (Ig) treatment was compared with a historical control population, equivalent in patient characteristics and disease severity. Using APACHE II scores, especially in the high- risk group (IgG), we could discriminate between low-risk patients (score < 19; mortality 1 percent) and the small groups at risk (score 19 to 23) and high risk (score > or = 24) with a significantly higher mortality (14 percent and 76 percent, respectively) [corrected]. Subsequently, among 1,341 consecutive patients we prospectively identified and treated (IgG n = 41 IgGMA: n = 25) these at-risk groups. In contrast to controls (risk: n = 21; high-risk; n = 21), we found a marked fall in APACHE II scores, especially in the high-risk group (IgG, n = 26: p < 0.05; IgGMA, n = 13: p = 0.08) [corrected]. In this group, Ig therapy produced higher (p < 0.05) response rates (score decrease 7 within 4 days: IgG: 54 percent, IgGMA: 62 percent; controls: 19 percent) and reduced mortality (IgG: 46 percent, IgGMA: 46 percent; controls: 76 percent), statistically significant (p < 0.05) for Ig treatment overall. Thus, early Ig treatment improves disease severity and may improve prognosis in prospectively score-identified high-risk postcardiac surgical patients.

This article has been cited by other articles:

				A Sablotzki, J Muhling, M G Dehne, B Zickmann, R E Silber, and I Friedrich Treatment of sepsis in cardiac surgery: role of immunoglobulins Perfusion, March 1, 2001; 16(2): 113 - 120. [Abstract] [PDF]