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Biagioni E, Tosi M, Berlot G, Castiglione G, Corona A, De Cristofaro MG, Donati A, Feltracco P, Forfori F, Fragranza F, Murino P, Piazza O, Tullo L, Grasselli G, D'Amico R, Girardis M. Adjunctive IgM-enriched immunoglobulin therapy with a personalised dose based on serum IgM-titres versus standard dose in the treatment of septic shock: a randomised controlled trial (IgM-fat trial). BMJ Open 2021; 11:e036616. [PMID: 33574139 PMCID: PMC7880103 DOI: 10.1136/bmjopen-2019-036616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION In patients with septic shock, low levels of circulating immunoglobulins are common and their kinetics appear to be related to clinical outcome. The pivotal role of immunoglobulins in the host immune response to infection suggests that additional therapy with polyclonal intravenous immunoglobulins may be a promising option in patients with septic shock. Immunoglobulin preparations enriched with the IgM component have largely been used in sepsis, mostly at standard dosages (250 mg/kg per day), regardless of clinical severity and without any dose adjustment based on immunoglobulin serum titres or other biomarkers. We hypothesised that a personalised dose of IgM enriched preparation based on patient IgM titres and aimed to achieve a specific threshold of IgM titre is more effective in decreasing mortality than a standard dose. METHODS AND ANALYSIS The study is designed as a multicentre, interventional, randomised, single-blinded, prospective, investigator sponsored, two-armed study. Patients with septic shock and IgM titres <60 mg/dL will be randomly assigned to an IgM titre-based treatment or a standard treatment group in a ratio of 1:1. The study will involve 12 Italian intensive care units and 356 patients will be enrolled. Patients assigned to the IgM titre-based treatment will receive a personalised daily dose based on an IgM serum titre aimed at achieving serum titres above 100 mg/dL up to discontinuation of vasoactive drugs or day 7 after enrolment. Patients assigned to the IgM standard treatment group will receive IgM enriched preparation daily for three consecutive days at the standard dose of 250 mg/kg. The primary endpoint will be all-cause mortality at 28 days. ETHICS AND DISSEMINATION The study protocol was approved by the ethics committees of the coordinating centre (Comitato Etico dell'Area Vasta Emilia Nord) and collaborating centres. The results of the trial will be published within 12 months from the end of the study and the steering committee has the right to present them at public symposia and conferences. TRIAL REGISTRATION DETAILS The trial protocol and information documents have received a favourable opinion from the Area Vasta Emilia Nord Ethical Committee on 12 September 2019. The trial protocol has been registered on EudraCT (2018-001613-33) on 18 April 2018 and on ClinicalTrials.gov (NCT04182737) on 2 December 2019.
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Affiliation(s)
- Emanuela Biagioni
- Anesthesia and Intensive Care, University Hospital Modena, Modena, Emilia-Romagna, Italy
| | - Martina Tosi
- Anesthesia and Intensive Care, University Hospital Modena, Modena, Emilia-Romagna, Italy
| | - Giorgio Berlot
- Anesthesia and Intensive Care Unit, Major Hospital of Trieste, Trieste, Friuli-Venezia Giulia, Italy
| | - Giacomo Castiglione
- Anesthesia and Intensive Care Unit, University Hospital Vittorio Emanuele Catania Polyclinic, Catania, Sicilia, Italy
| | - Alberto Corona
- Anesthesia and Intensive Care Unit, Luigi Sacco University Hospital, Milano, Lombardia, Italy
| | | | - Abele Donati
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Paolo Feltracco
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera di Padova, Padova, Veneto, Italy
| | - Francesco Forfori
- Anesthesia and Intensive Care Unit, Pisa University Hospital, Pisa, Toscana, Italy
| | | | - Patrizia Murino
- Anesthesia and Intensive Care Unit, Monaldi Hospital, Napoli, Campania, Italy
| | - Ornella Piazza
- Anesthesia and Intensive Care Unit, University of Salerno, Fisciano, Campania, Italy
| | - Livio Tullo
- Anesthesia and Intensive Care Unit, Foggia University Hospital, Foggia, Puglia, Italy
| | - Giacomo Grasselli
- Anesthesia and Intensive Care Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Lombardia, Italy
| | - Roberto D'Amico
- Medical and Surgical Science, University Hospital Modena, Modena, Emilia-Romagna, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care, University Hospital Modena, Modena, Emilia-Romagna, Italy
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Sakr Y, Elia C, Mascia L, Barberis B, Cardellino S, Livigni S, Fiore G, Filippini C, Ranieri VM. Being overweight or obese is associated with decreased mortality in critically ill patients: a retrospective analysis of a large regional Italian multicenter cohort. J Crit Care 2012; 27:714-21. [PMID: 23102526 DOI: 10.1016/j.jcrc.2012.08.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 08/08/2012] [Accepted: 08/19/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the epidemiology of obesity in a large cohort of intensive care unit (ICU) patients and study its impact on outcomes. METHODS All 3902 patients admitted to one of 24 ICUs in the Piedmont region of Italy from April 3 to September 29, 2006, were included in this retrospective analysis of data from a prospective, multicenter study. RESULTS Mean body mass index (BMI) was 26.0 ± 5.4 kg/m(2): 32.8% of patients had a normal BMI, 2.6% were underweight, 45.1% overweight, 16.5% obese, and 2.9% morbidly obese. ICU mortality was significantly (P < .05) lower in overweight (18.8%) and obese (17.5%) patients than in those of normal BMI (22%). In multivariate logistic regression analysis, being overweight (OR = 0.73; 95%CI: 0.58-0.91, P = .007) or obese (OR = 0.62; 95%CI: 50.45-0.85, P = .003) was associated with a reduced risk of ICU death. Being morbidly obese was independently associated with an increased risk of death in elective surgery patients whereas being underweight was independently associated with an increased risk of death in patients admitted for short-term monitoring and after elective surgery. CONCLUSIONS In this cohort, overweight and obese patients had a reduced risk of ICU death. Being underweight or morbidly obese was associated with an increased risk of death in some subgroups of patients.
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Affiliation(s)
- Yasser Sakr
- Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Erlanger Allee 103, 07743 Jena, Germany.
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