Prague Med. Rep. 2013, 114, 246-257

https://doi.org/10.14712/23362936.2014.14

Presence of Hypogammaglobulinemia – A Risk Factor of Mortality in Patients with Severe Sepsis, Septic Shock, and SIRS

Miroslav Průcha1,*, R. Zazula2, I. Herold3, M. Dostál4,  T. Hyánek5, G. Bellingan6

1Department of Clinical Biochemistry, Hematology and Immunology, Na Homolce Hospital, Prague, Czech Republic
2Department of  Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and  Thomayer Hospital, Prague, Czech Republic
3Department of  Anaesthesiology and Intensive Care Medicine, Klaudian’s Hospital, Mladá Boleslav, Czech Republic
4Institute of Experimental Medicine,  Academy of Sciences, Prague, Czech Republic
5Department of Intensive Care Medicine, Na Homolce Hospital, Prague, Czech Republic
6UCL Department of Medicine and NIHR University College London Hospitals, Biomedical Research Centre, London, United Kingdom

In this retrospective study we assessed the frequency of hypogammaglobulinemia in 708 patients with SIRS, severe sepsis and septic shock. We evaluated the relationship between hypogammaglobulinemia IgG, IgM and 28 day mortality. Total of 708 patients and 1,513 samples were analyzed. In the three subgroups we investigated, patients met the criteria of SIRS, severe sepsis and septic shock. IgG hypogammaglobulinemia was demonstrated in 114 patients with severe sepsis (25.2%), 11 septic shock patients (24.4%), and in 29 SIRS patients (13.9%). IgM hypogammaglobulinemia was documented in 55 patients with severe sepsis (12.2%), 6 septic shock patients (13.3%), and in 17 SIRS patients (8.1%). Mortality of patients with severe sepsis and normal IgG levels was significantly lower (111 patients; 32.8%) compared with those with IgG hypogammaglobulinemia (49 patients; 43.0%; p=0.001). Mortality of patients with septic shock and IgG hypogammaglobulinemia (n=5) was significantly higher compared with those with normal IgG levels (45.5% vs. 38.2%; p=0.001). Mortality of patients with severe sepsis and IgM hypogammaglobulinemia did not differ from that of patients with normal IgM levels (37.0 vs. 41.8%). Mortality of patients with septic shock and IgM hypogammaglobulinemia was significantly higher compared with those with normal IgM levels (50% vs. 38.5%; p=0.0001). This study documented relatively high incidence of hypogammaglobulinemia IgG and IgM in patients with severe sepsis, septic shock and SIRS respectively. The presence of IgG hypogammaglobulinemia in patients with severe sepsis is independent factor of mortality.

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