# The Efficacy of IgM-Enriched Immunoglobulin (eIg) Administration for Treatment of Sepsis and Septic Shock in Adult Surgical Patients: A Single-Center, Retrospective, Observational Study

## TL;DR

This study suggests that IgM-enriched immunoglobulin may reduce mortality in surgical patients with sepsis, though it increases ICU and ventilation duration.

## Contribution

The study evaluates the efficacy of IgM-enriched immunoglobulin in reducing mortality in surgical sepsis patients through a retrospective observational design.

## Key findings

- eIg administration was associated with reduced ICU and in-hospital mortality in surgical sepsis patients.
- Treated patients had longer ICU stays and mechanical ventilation durations compared to untreated patients.
- The study highlights the potential of eIg as an adjuvant therapy for sepsis despite its observational limitations.

## Abstract

Background: Surgical sepsis, particularly secondary peritonitis, is a leading cause of ICU admissions, with mortality rates reaching 40%. In recent decades, several adjuvant therapies have been proposed in addition to standard of care to modulate the inflammatory response and support organ function. In our study, we aimed to evaluate the efficacy of IgM-enriched immunoglobulin (eIg) treatment on outcome of adult surgical patients with sepsis and septic shock. Methods: A single-center, retrospective, observational study was conducted from January 2016 to December 2019 in the Intensive Care Unit of Pisa University Hospital. Patients with sepsis or septic shock resulting from primary or postoperative infections undergoing surgical source control were included. The primary outcome was to investigate the impact of eIg administration on in-hospital mortality. The secondary outcomes were the ICU length of stay, days of ventilation, and vasoactive drug administration. A propensity score through inverse probability weighting was used to control for measured confounding variables. Results: A total of 108 patients, categorized into two groups based on whether they received eIg, were included during the study period. Compared to the untreated group, patients who received eIg showed a significant reduction in ICU mortality (ATE −0.17, 95% CI −0.33 to −0.03; p = 0.023) and in-hospital mortality (ATE −0.18, 95% CI −0.34 to −0.03; p = 0.022). However, the ICU length of stay and the duration of mechanical ventilation were significantly longer in the treated group (ATE + 7.1 days, 95% CI 3.1 to 11.1; p = 0.001 and ATE + 4.5 days, 95% CI 1.0 to 7.9; p = 0.011, respectively). No other statistically significant differences were observed. Conclusions: Despite the significant limitations of its observational nature, our study suggests that administering eIg may reduce ICU and in-hospital mortality in surgical patients with sepsis and septic shock.