Supplemental immune globulins in sepsis

Intravenous immune globulins are widely used as sup plemental treatment of sepsis, septic shock and systemic inflammation in the critically ill, altho ugh this indication has at best been validated in part. Likely beneficial m echanisms of action may include the im provement of serum bactericidal acti vity due to neutralizing and opsonizing immunoglobulin (Ig)G- and Igm-antib odies, as well as stimulation of phagocytosis and neutralization of bacteri al endo- and exotoxins; another attractive mode of action may represent im mune globulin-mediated modification and specific suppression of proinflamma tory cytokine release from endotoxin- and superantigen-activated blood cell s. For the "entire group of patients with sepsis and septic shock" a reduct ion in mortality by intravenous immune globulin could not be documented; ho wever, in the score-based immunoglobulin in sepsis (SBITS) study with 653 p atients included, a moderate improvement in sepsis morbidity and multiple o rgan dysfunction syndrome was demonstrated. In defined sepsis subgroups, a reduction in mortality by intravenous im mune globulin has been seen in ind ividual small, not yet confirmed trials. Finally, the incidence of some sev ere infections in well characterized "patients at risk" and "operations at risk" is reduced by intravenous im mune globulin prophylaxis. Thus, intrave nous immune globulin is not a "magic bullet" of sepsis treatment, but it ma y reduce morbidity and thereby represent a useful piece of stone in the the rapeutic mosaic of sepsis treatment.