SERUM IMMUNOGLOBULIN LEVELS AND ANTIBODY- TITERS OF SEVERELY BURNED PATIENTS FOLLOWING PROPHYLACTIC INTRAVENOUS IMMUNOGLOBULIN REPLACEMENT WITH A PSEUDOMONAS IMMUNOGLOBULIN

In a randomized clinical trial 30 patients with bum injury received su pportive therapy with a Pseudomonas hyperimmunoglobulin (Psomaglobin N ). The control group received no additional therapy. The patients of b oth groups were between 15 and 60 years of age and had a full-thicknes s bum of 30-70% of the body surface area with inhalational trauma bein g optional. The whole trauma was classified and scored with the 'Abbre viated Bum Severity Index' (which allows another extra score point for inhalational trauma). Both groups underwent the same intensive care u nit treatment with preference to early wound excision and wound grafti ng following functional aspects of reconstructive surgery. Bacteriolog ical monitoring was performed on suspicion of wound infection and bact eremia by taking wound swabs and blood cultures. The supportive treatm ent group received a total of 250 mg/kg hyperimmunoglobulin on days 3, 5, 7, 10, and 13. Of 30 patients in the control group 16 had an addit ional inhalation trauma, and 8 of those (50%) died (only 1 of 14 patie nts without inhalation trauma died). In the group receiving supportive treatment, 23 out of 30 patients had an inhalation trauma, and 8 of t hose (35%) died (1 of 7 patients without inhalation trauma). In both g roups with inhalation injury, the patients were at risk of developing bacteremia: 13 of 23 of the immunoglobulin-treated patients and 12 of 16 patients of the control group. Bacteremic controls died at a lower score than bacteremic immunoglobulin-treated patients (8.6 vs. 10.3 po ints). In the patients with inhalation injury the IgG levels increased continuously in both treatment groups. In the patients with bacteremi a, the IgG levels took a similar course. Regarding the levels of antib odies against the Fisher immunotype 1, the patients receiving immunogl obulin showed higher concentrations until the 10th day. On days 13 and 16 the levels were higher in the control group. In both groups, the p atients who died seemed to have lower levels of type 1 antibody on day s 10 and 13. In the patients with bacteremia no differences were seen among both groups during the first week, regardless of survival. For d ays 10 and 13 an obvious steep rise in type 1 antibody occurred in pat ients who finally survived. This rise was missing in patients who died . The levels of Fisher type 4 antibody at all points of time were high er in the immunoglobulin-treated than in the control group. Conclusion s: After bum injury, mortality seems to be mainly associated with the severity of trauma in both groups. A higher probability of survival in the high-risk groups with inhalation injury and bacteremia might be t he benefit of Psomaglobin substitution. Lower levels of IgG and type 1 antibodies might hint at the fact that those patients have a greater risk of dying.