How Appropriate to Use Intravenous Immunoglobulin in Sepsis? Humoral Immunodeficiencies as the Key to Getting the Right Answer

D.V. Maltsev

Abstract


In the latest Cochrane review on immunoglobulin therapy for sepsis in adults, a lack of the effect of the drug on mortality is indicated according to the results of clinical trials with a low risk of bias. These findings are contrary to the concepts of fundamental immunology, the results of experimental studies and data of several meta-analysis and systematic reviews of randomized trials that examined the efficacy of intravenous (i/v) immunoglobulin in sepsis. In this review, the criticisms formulated to design research on immunoglobulin therapy for sepsis to find possible errors that could affect the outcome. Lack of adequate placebo control, the use of albumin as a placebo, poor standardization of other interventions, the use of duplicate and antagonistic strategies could lead to errors in the test results. Besides, it is necessary to take into account the etiological microbial agents, form and origin of sepsis, including the mechanism of the port of infection, the phase of the pathological process, immune status, including humoral immunity, comorbid pathology, the nature of complications, the differences in the composition, antimicrobial and immunomodulatory properties of drugs of various manufacturers. All these factors influence the dosage of i/v immunoglobulin, in the change of which the therapeutic effect of the drug to be transformed from an immunomodulatory to antiinflammatory. It is necessary to expand the list of endpoints of research, since i/v immunoglobulin can provide a number of additional positive effects in sepsis, such as to compensate sepsis-induced coagulopathy.


Keywords


sepsis; i/v immunoglobulin; randomized clinical trials

References


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DOI: https://doi.org/10.22141/2224-0586.6.69.2015.78667

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