Objective: To investigate the activity of intravenous immunoglobulin (IVIG)
as a prophylactic agent against infection in trauma victims.
Design: Prospective, randomized, double-blind, placebo-controlled study.
Setting: A 20-bed university intensive care unit.
Patients: Thirty-nine trauma patients with injury severity scores (ISSs) of
16-50.
Interventions: Penicillin was given at the time of admission and continued
at least until day 4. Twenty-one patients received IVIG and 18 patients rec
eived human albumin at 1 g/kg in four divided doses (days 1, 2, 3, and 6).
The two groups had similarities in age, gender, Acute Physiology and Chroni
c Health Evaluation II score, risk of death, and Glasgow Coma Scale score,
but differing ISSs (p = .02), at the time of admission. Blood was collected
on days 1, 4, and 7.
Measurements and Main Results: Clinical variables related to infection were
recorded. The complement components C3c, C4 and CH50, IgG, and the fractio
ns of IgG were measured. The serum bactericidal activity (S8A) was assessed
at 37 degrees C (98.6 degrees F) and 40 degrees C (104.0 degrees F) at the
time of admission and during the course of IVIG administration.
Controlling for ISS, IVIG-treated patients had fewer pneumonias (p = .003)
and total non-catheter-related infections (p = .04). Catheter-related infec
tions (p = .76), length of stay in the intensive care unit, antibiotic days
, and infection-related mortality did not differ between the two groups. A
significantly increased trend in IgG and its subclasses was shown on days 4
and 7 in the IVIG group but not in the control group (p < .000001). No imp
ortant differences were noted in complement fractions. The SEA of the group
s was similar on day 1, but significantly higher on days 4 and 7 (p < .0000
01) in the IVIG group, remaining so controlling for complement and ISS. SBA
was higher at 40 degrees C (104.0 degrees F) compared with 37 degrees C (9
8.6 degrees 5) (p < .0001) under all three conditions. In both groups, low
SEA (on days 1, 4, and 7) was associated with increased risk of pneumonia (
p < .01) and non-catheter-related infections (p = .06 for day 1; p < .01 fo
r days 4 and 7).
Conclusions: Trauma patients receiving high doses of IVIG exhibit a reducti
on of septic complications and an improvement of SEA. Early SEA measurement
may represent an index of susceptibility to infection.