Immunoglobulin deficiency among children with severe overwhelming sepsis admitted to Alexandria University Pediatric Intensive Care Unit: a cross-sectional study

Abstract

Background Worldwide, severe overwhelming sepsis is still a major cause of morbidity and mortality, especially among infants and children. Most severe sepsis and septic shock deaths are due to dysregulated immune response, resulting in multiple organ dysfunction, a part of which is low immunoglobulin (Ig) levels. Hypogammaglobulinemia is a frequent finding in patients with severe sepsis and septic shock, although it is not clear whether it is a cause or a consequence of sepsis. Aim The purpose of this study was to evaluate the incidence of Igs deficiency and its relation to mortality among children with severe overwhelming sepsis admitted to Alexandria University Pediatric Intensive Care Unit. Patients and methods A cross-sectional study was conducted on 40 patients with severe sepsis and/or septic shock during an 18-month period at Pediatric Intensive Care Unit of Alexandria University Children’s Hospital and 40 age-matched control group admitted to the ward with an infectious process. Their age ranged from 12 months to 12 years. All patients were subjected to history taking and routine investigations done at admission. Serum from the initial blood draw was collected and stored at −70°C to measure the level of total IgG, IgM, and IgA by immunoturbidimetric assay. Results In the severe sepsis/septic shock group, 55.26% of the patients had a deficiency in total Igs (low IgG, IgM, and IgA in 55.26, 5.26, and 21.05%, respectively) versus 17.5% in controls (low IgG, IgM, and IgA in 12.5, 0, and 7.5%, respectively). The overall mortality among the patients with severe sepsis/septic shock was high (34.21%), and the likelihood of death for Igs-deficient patients was 3.916 times more than the Igs-normal patients (P=0.048), whereas all patients in the control group survived. Survival curve analysis revealed the significant predictive ability of IgG to detect early mortality. Receiver operating characteristic curve analysis revealed the significant predictive ability of the relative concentrations of IgG, IgM, and IgA (P=0.0019, P<0.0001, and P=0.0217, respectively) at day 1 to detect mortality. Conclusion We documented relatively high frequencies of low IgG, IgM, and IgA in patients with severe sepsis and septic shock, and also low levels of IgG and IgM were an independent risk factor of mortality. The role of hypogammaglobulinemia in patients with severe sepsis and septic shock clearly warrants future controlled clinical trials with intravenous immunoglobulin use in this disease category.