The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysis
Abstract Background Sepsis is characterized by a complex immune response. This meta-analysis evaluated the clinical effectiveness of intravenous IgM-enriched immunoglobulin (IVIgGM) in patients with sepsis and septic shock. Methods Four databases, PubMed, the Cochrane Library, the ISI Web of Knowled...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2019-02-01
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| Series: | Annals of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13613-019-0501-3 |
| _version_ | 1818409800123285504 |
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| author | Jie Cui Xuxia Wei Haijin Lv Yuntao Li Ping Li Zhen Chen Genglong Liu |
| author_facet | Jie Cui Xuxia Wei Haijin Lv Yuntao Li Ping Li Zhen Chen Genglong Liu |
| author_sort | Jie Cui |
| collection | DOAJ |
| description | Abstract Background Sepsis is characterized by a complex immune response. This meta-analysis evaluated the clinical effectiveness of intravenous IgM-enriched immunoglobulin (IVIgGM) in patients with sepsis and septic shock. Methods Four databases, PubMed, the Cochrane Library, the ISI Web of Knowledge, and Embase, were systematically searched from inception to June 2018 to update the 2013 edition of the Cochrane review by two investigators, who independently selected studies, extracted relevant data, and evaluated study quality. Data were subjected to a meta-analysis and trial sequential analysis (TSA) for the primary and secondary outcomes. Level of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scale. Results Nineteen studies comprising 1530 patients were included in this meta-analysis. Pooled analyses showed that the use of IVIgGM reduced the mortality risk of septic patients (relative risk 0.60; 95% confidence interval [CI] 0.52–0.69, I 2 = 0%). TSA showed that IVIgGM had a significant effect on mortality. Additionally, the meta-analysis suggested that use of IVIgGM shortened length of mechanical ventilation (mean difference − 3.16 days; 95% CI − 5.71 to − 0.61 days) and did not shorten length of stay in the intensive care unit (mean difference − 0.38 days; 95% CI − 3.55 to 2.80 days). The GRADE scale showed that the certainty of the body of evidence was low for both benefits and IVIgGM. Conclusion Administration of IVIgGM to adult septic patients may be associated with reduced mortality. Treatment effects tended to be smaller or less consistent when including only those studies deemed adequate for each indicator. The available evidence is not clearly sufficient to support the widespread use of IVIgGM in the treatment of sepsis. Trial registration PROSPERO registration number: CRD42018084120. Registered on 11 February 2018. |
| first_indexed | 2024-12-14T10:05:23Z |
| format | Article |
| id | doaj.art-3f4acdc048fa48c4add5f81e81522ad4 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-14T10:05:23Z |
| publishDate | 2019-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-3f4acdc048fa48c4add5f81e81522ad42022-12-21T23:07:09ZengSpringerOpenAnnals of Intensive Care2110-58202019-02-019111410.1186/s13613-019-0501-3The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysisJie Cui0Xuxia Wei1Haijin Lv2Yuntao Li3Ping Li4Zhen Chen5Genglong Liu6Head and Neck Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical UniversitySurgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen UniversitySurgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen UniversityNursing Department, Shaodong County People’s HospitalDepartment of Anesthesia, GuangDong Provincial Hospital of Chinese MedicineIntensive Care Unit, Shunde Hospital, Southern Medical UniversityDepartment of Pathology, Affiliated Cancer Hospital & Institute of Guangzhou Medical UniversityAbstract Background Sepsis is characterized by a complex immune response. This meta-analysis evaluated the clinical effectiveness of intravenous IgM-enriched immunoglobulin (IVIgGM) in patients with sepsis and septic shock. Methods Four databases, PubMed, the Cochrane Library, the ISI Web of Knowledge, and Embase, were systematically searched from inception to June 2018 to update the 2013 edition of the Cochrane review by two investigators, who independently selected studies, extracted relevant data, and evaluated study quality. Data were subjected to a meta-analysis and trial sequential analysis (TSA) for the primary and secondary outcomes. Level of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scale. Results Nineteen studies comprising 1530 patients were included in this meta-analysis. Pooled analyses showed that the use of IVIgGM reduced the mortality risk of septic patients (relative risk 0.60; 95% confidence interval [CI] 0.52–0.69, I 2 = 0%). TSA showed that IVIgGM had a significant effect on mortality. Additionally, the meta-analysis suggested that use of IVIgGM shortened length of mechanical ventilation (mean difference − 3.16 days; 95% CI − 5.71 to − 0.61 days) and did not shorten length of stay in the intensive care unit (mean difference − 0.38 days; 95% CI − 3.55 to 2.80 days). The GRADE scale showed that the certainty of the body of evidence was low for both benefits and IVIgGM. Conclusion Administration of IVIgGM to adult septic patients may be associated with reduced mortality. Treatment effects tended to be smaller or less consistent when including only those studies deemed adequate for each indicator. The available evidence is not clearly sufficient to support the widespread use of IVIgGM in the treatment of sepsis. Trial registration PROSPERO registration number: CRD42018084120. Registered on 11 February 2018.http://link.springer.com/article/10.1186/s13613-019-0501-3SepsisIgM-enriched immunoglobulinMortalityTrial sequential analysis |
| spellingShingle | Jie Cui Xuxia Wei Haijin Lv Yuntao Li Ping Li Zhen Chen Genglong Liu The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysis Annals of Intensive Care Sepsis IgM-enriched immunoglobulin Mortality Trial sequential analysis |
| title | The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysis |
| title_full | The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysis |
| title_fullStr | The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysis |
| title_full_unstemmed | The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysis |
| title_short | The clinical efficacy of intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock: a meta-analysis with trial sequential analysis |
| title_sort | clinical efficacy of intravenous igm enriched immunoglobulin pentaglobin in sepsis or septic shock a meta analysis with trial sequential analysis |
| topic | Sepsis IgM-enriched immunoglobulin Mortality Trial sequential analysis |
| url | http://link.springer.com/article/10.1186/s13613-019-0501-3 |
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