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Evidence summaries

Intravenous Immunoglobulin for Treating Sepsis and Septic Shock

Polychlonal intravenous immunoglobulin might possibly reduce mortality in sepsis, but monochlonal antibodies may not be effective, although the evidence is insufficient. Level of evidence: "D"

A Cochrane review[Abstract] 1 included 43 studies Subgroup analysis of 10 polyclonal IVIG trials in adults (n = 1 430) and seven trials on IgM-enriched polyclonal IVIG (n = 528) showed significant reductions in mortality compared to placebo or no intervention (RR 0.81, 95% CI 0.70 to 0.93 and RR 0.66, 95% CI 0.51 to 0.85, respectively). Subgroup analysis of polyclonal IVIG in neonates showed no significant reduction in mortality for standard (RR 1.00, 95% CI 0.92 to 1.08; 5 studies, n = 3667) and IgM-enriched polyclonal IVIG (RR 0.57, 95% CI 0.31 to 1.04; 3 studies, n = 164). Sensitivity analysis of trials with low risk of bias showed no reduction in mortality with polyclonal IVIG in adults (RR 0.97, 95% CI 0.81 to 1.15; 5 studies, n = 945) and neonates (RR 1.01, 95% CI 0.93 to 1.09; 3 studies, n = 3561). Mortality was not reduced among patients (8 studies, n = 4 671) who received anti-endotoxin antibodies (RR 0.99, 95% CI 0.91 to 1.06) while anti-cytokines (9 studies, n = 7 893) demonstrated a marginal reduction in mortality (RR 0.92, 95% CI 0.86 to 0.97).

Comment: The quality of evidence is downgraded by study quality, by inconsistency (variability in results across studies), and by potential reporting bias.

    References

    • Alejandria MM, Lansang MA, Dans LF et al. Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock. Cochrane Database Syst Rev 2013;(9):CD001090. [PubMed]

Primary/Secondary Keywords