社区获得性肺炎危重患者免疫球蛋白反应与疾病进展的纵向评估

IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE Critical Care Pub Date : 2024-12-05 DOI:10.1186/s13054-024-05197-3
Emma Rademaker, Lisette M. Vernooij, Tom van der Poll, Marc J. M. Bonten, Helen Leavis, Olaf L. Cremer, Lennie P. G. Derde
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引用次数: 0

摘要

低内源性免疫球蛋白(Ig)水平在危重症脓毒症患者中很常见,但目前尚不清楚低igg水平是否与不良预后相关,以及在哪些患者中,igg替代疗法(IgRT)可改善预后。鉴于免疫球蛋白在消除某些包膜病原体方面的关键作用,我们研究了由包膜病原体或其他病原体引起的社区获得性肺炎(sCAP)危重患者系列igg水平与病程之间的关系。我们纳入了一组连续的危重患者,他们患有CAP, PaO2/ fio2比< 200,伴有或不伴有感染性休克,他们来自一个现有的生物库,在那里微生物学感染原因已经以一种规范的方式被确定。我们使用广义线性混合模型来评估全因sCAP和肺炎链球菌或流感嗜血杆菌引起的发作中IgG和IgM(在入院第1,3和7天测量)与病程(第2,4和8天的顺序器官衰竭评估(SOFA)评分)之间的关系。我们纳入了255例符合条件的CAP患者,其中82例(32%)发作是由肺炎链球菌或流感嗜血杆菌引起的。151例(59%)患者IgG水平低(< 7.0 g/L), 77例(30%)患者IgM水平低(< 0.4 g/L), 56例(22%)患者两者兼有。较低的IgG水平与入院时略高的sofa评分相关(β = - 0.07 / 1 g/L IgG, p = 0.029),但随着时间的推移,IgG水平下降与sofa评分升高无关(β = - 0.04, p = 0.564)。igm水平与sofa评分随时间的变化无关。两种关联均不受肺炎链球菌和流感嗜血杆菌存在与否的影响。在CAP危重患者中,无论致病病原体是什么,ICU住院第一周IgG和IgM动态与病程的临床相关变化无关。
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Longitudinal assessment of immunoglobulin response and disease progression in critically ill patients with community acquired pneumonia
Low endogenous immunoglobulin(Ig)-levels are common in critically ill patients with sepsis, but it is unknown whether low Ig-levels are associated with poor outcome, and in which patients Ig-replacement therapy (IgRT) improves outcome. Given the crucial role of immunoglobulins in eliminating certain encapsulated pathogens, we examined the relationship between serial Ig-levels and disease course in critically ill patients with community acquired pneumonia (sCAP) caused by encapsulated or other pathogens. We included a cohort of consecutive critically ill patients with CAP, and PaO2/FiO2-ratio < 200 with or without septic shock, from an existing biorepository where microbiological causes of infection had been adjudicated in a protocolized manner. We used generalized linear mixed models to assess the association between IgG and IgM (measured on admission days 1, 3 and 7) and disease course (Sequential Organ Failure Assessment (SOFA)-score on day 2, 4, and 8) for all-cause sCAP and for episodes caused by Streptococcus (S.) pneumoniae or Haemophilus (H.) influenzae. We included 255 eligible patients admitted with CAP, of which 82 (32%) episodes were caused by S. pneumoniae or H. influenzae. 151 (59%) patients had low IgG (< 7.0 g/L), 77 (30%) had low IgM (< 0.4 g/L), and 56 (22%) had both. A lower IgG-level was related to a slightly higher SOFA-score at admission (β = − 0.07 per 1 g/L IgG, p = 0.029), but an IgG-level decline over time was not associated with a SOFA-score increase (β = − 0.04, p = 0.564). IgM-levels were not associated with changes in SOFA-score over time. Neither association was affected by the presence or absence of S. pneumoniae and H. influenzae. In critically ill patients with CAP, IgG and IgM dynamics in the first week of ICU stay are not associated with clinically relevant changes in disease course, regardless of the causative pathogen.
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来源期刊
Critical Care
Critical Care 医学-危重病医学
CiteScore
20.60
自引率
3.30%
发文量
348
审稿时长
1.5 months
期刊介绍: Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.
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