Plasma IgM Levels Differentiate between Survivors and Non-Survivors of Culture-Positive and Culture-Negative Sepsis and SIRS: A Pilot Study

Immunoglobulin IgM is important for controlling viral and bacterial infections, and low immunoglobulin levels have been found in sepsis. There is a clear need to stratify sepsis patients according to the presence of an invading organism, compared to no organism identified, and SIRS patients, where o...

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Autores principales:	Navichandra Pathare, Tamas Szakmany, Judith E. Hall, Meike Heurich
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	immunoglobulins sepsis SIRS culture-negative Medicine R
Acceso en línea:	https://doaj.org/article/f462d5e067774589b2959b2093966f79
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spelling	oai:doaj.org-article:f462d5e067774589b2959b2093966f792021-11-25T18:02:22ZPlasma IgM Levels Differentiate between Survivors and Non-Survivors of Culture-Positive and Culture-Negative Sepsis and SIRS: A Pilot Study10.3390/jcm102253912077-0383https://doaj.org/article/f462d5e067774589b2959b2093966f792021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5391https://doaj.org/toc/2077-0383Immunoglobulin IgM is important for controlling viral and bacterial infections, and low immunoglobulin levels have been found in sepsis. There is a clear need to stratify sepsis patients according to the presence of an invading organism, compared to no organism identified, and SIRS patients, where organ dysfunction is a result of a non-infective process. The aim of this pilot study in a small cohort of patients with sepsis was to evaluate the association between IgM plasma levels and survival in 47 patients with sepsis and 11 patients diagnosed with organ failure without the identification of a pathogen (SIRS). Patients were admitted to the intensive care unit (ICU) at The Royal Glamorgan Hospital, Llantrisant, UK between 2010 and 2014. We found that low IgM levels were associated with sepsis, but not SIRS. IgM levels did not differ significantly for culture-positive (CP) compared with culture-negative (CN, no organism found) sepsis samples. Kaplan–Meier analysis was used to compare survival curves according to IgM levels, with no significant difference. We observed significantly higher survival in the CP samples when comparing with CN. Cut-off value for IgM (266 μg/mL) for diagnosis of sepsis patients was determined using receiver operator characteristic (ROC) curves with 70% sensitivity, 69% specificity and 92% negative predictive values (NPV), respectively. The corresponding area under the curve (AUC) for the discrimination of sepsis patients was AUC = 0.73, and in a subgroup analysis of CP was AUC = 0.77 and for CN was AUC = 0.79. We confirm IgM as a good diagnostic marker of sepsis. These findings indicate a difference in the pathology between culture-positive versus negative sepsis, SIRS and survival. This indicates that IgM is likely relevant to pathology, because of its role in the early immune response against pathogens, the potentially protective role of natural IgM antibodies, and supports its application in immunoglobulin therapy.Navichandra PathareTamas SzakmanyJudith E. HallMeike HeurichMDPI AGarticleimmunoglobulinssepsisSIRSculture-negativeMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5391, p 5391 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	immunoglobulins sepsis SIRS culture-negative Medicine R
spellingShingle	immunoglobulins sepsis SIRS culture-negative Medicine R Navichandra Pathare Tamas Szakmany Judith E. Hall Meike Heurich Plasma IgM Levels Differentiate between Survivors and Non-Survivors of Culture-Positive and Culture-Negative Sepsis and SIRS: A Pilot Study
description	Immunoglobulin IgM is important for controlling viral and bacterial infections, and low immunoglobulin levels have been found in sepsis. There is a clear need to stratify sepsis patients according to the presence of an invading organism, compared to no organism identified, and SIRS patients, where organ dysfunction is a result of a non-infective process. The aim of this pilot study in a small cohort of patients with sepsis was to evaluate the association between IgM plasma levels and survival in 47 patients with sepsis and 11 patients diagnosed with organ failure without the identification of a pathogen (SIRS). Patients were admitted to the intensive care unit (ICU) at The Royal Glamorgan Hospital, Llantrisant, UK between 2010 and 2014. We found that low IgM levels were associated with sepsis, but not SIRS. IgM levels did not differ significantly for culture-positive (CP) compared with culture-negative (CN, no organism found) sepsis samples. Kaplan–Meier analysis was used to compare survival curves according to IgM levels, with no significant difference. We observed significantly higher survival in the CP samples when comparing with CN. Cut-off value for IgM (266 μg/mL) for diagnosis of sepsis patients was determined using receiver operator characteristic (ROC) curves with 70% sensitivity, 69% specificity and 92% negative predictive values (NPV), respectively. The corresponding area under the curve (AUC) for the discrimination of sepsis patients was AUC = 0.73, and in a subgroup analysis of CP was AUC = 0.77 and for CN was AUC = 0.79. We confirm IgM as a good diagnostic marker of sepsis. These findings indicate a difference in the pathology between culture-positive versus negative sepsis, SIRS and survival. This indicates that IgM is likely relevant to pathology, because of its role in the early immune response against pathogens, the potentially protective role of natural IgM antibodies, and supports its application in immunoglobulin therapy.
format	article
author	Navichandra Pathare Tamas Szakmany Judith E. Hall Meike Heurich
author_facet	Navichandra Pathare Tamas Szakmany Judith E. Hall Meike Heurich
author_sort	Navichandra Pathare
title	Plasma IgM Levels Differentiate between Survivors and Non-Survivors of Culture-Positive and Culture-Negative Sepsis and SIRS: A Pilot Study
title_short	Plasma IgM Levels Differentiate between Survivors and Non-Survivors of Culture-Positive and Culture-Negative Sepsis and SIRS: A Pilot Study
title_full	Plasma IgM Levels Differentiate between Survivors and Non-Survivors of Culture-Positive and Culture-Negative Sepsis and SIRS: A Pilot Study
title_fullStr	Plasma IgM Levels Differentiate between Survivors and Non-Survivors of Culture-Positive and Culture-Negative Sepsis and SIRS: A Pilot Study
title_full_unstemmed	Plasma IgM Levels Differentiate between Survivors and Non-Survivors of Culture-Positive and Culture-Negative Sepsis and SIRS: A Pilot Study
title_sort	plasma igm levels differentiate between survivors and non-survivors of culture-positive and culture-negative sepsis and sirs: a pilot study
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/f462d5e067774589b2959b2093966f79
work_keys_str_mv	AT navichandrapathare plasmaigmlevelsdifferentiatebetweensurvivorsandnonsurvivorsofculturepositiveandculturenegativesepsisandsirsapilotstudy AT tamasszakmany plasmaigmlevelsdifferentiatebetweensurvivorsandnonsurvivorsofculturepositiveandculturenegativesepsisandsirsapilotstudy AT judithehall plasmaigmlevelsdifferentiatebetweensurvivorsandnonsurvivorsofculturepositiveandculturenegativesepsisandsirsapilotstudy AT meikeheurich plasmaigmlevelsdifferentiatebetweensurvivorsandnonsurvivorsofculturepositiveandculturenegativesepsisandsirsapilotstudy
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Plasma IgM Levels Differentiate between Survivors and Non-Survivors of Culture-Positive and Culture-Negative Sepsis and SIRS: A Pilot Study

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