RESUMO
BACKGROUND: Although some studies conducted outside of Japan have addressed the effectiveness of intravenous immunoglobulins (IVIG) in treating infections, the dosing regimens and amounts used in Japan are very different from those reported. Here, we investigate the effectiveness of single-dose administration of IVIG in sepsis patients in Japan. METHODS: We analyzed 79 patients admitted to the intensive care unit (ICU) of a tertiary care institution due to severe sepsis or septic shock. Patients were randomly divided into a group that was administered standard divided doses of IVIG (5 g/day for 3 days, designated the S group) or a group that was administered a standard single dose of IVIG (15 g/day for 1 day, H group); freeze-dried sulfonated human IVIG was used. The longitudinal assessment of procalcitonin (PCT) levels, C-reactive protein (CRP) levels, white blood cell count, blood lactate levels, IL-6 levels, Sequential Organ Failure Assessment (SOFA) score, and Systemic Inflammatory Response Syndrome (SIRS) was conducted. We also assessed mechanical ventilation duration (days), ICU stay (days), 28-day survival rate, and 90-day survival rate. RESULTS: The study showed no significant differences in PCT levels, CRP levels, 28-day survival rate, and 90-day survival rate between the two groups. However, patients in the H group showed improvements in the various SIRS diagnostic criteria, IL-6 levels, and blood lactate levels in the early stages after IVIG administration. In light of the non-recommendation of IVIG therapy in the Surviving Sepsis Campaign Guidelines 2012, our findings of significant early post-administration improvements are noteworthy. IVIG's anti-inflammatory effects may account for the early reduction in IL-6 levels after treatment, and the accompanying improvements in microcirculation may improve blood lactate levels and reduce SOFA scores. However, the low dosages of IVIG in Japan may limit the anti-cytokine effects of this treatment. Further studies are needed to determine appropriate treatment regimens of single-dose IVIG. CONCLUSIONS: In this study, we investigated the effectiveness of single-dose IVIG treatment in patients with severe sepsis or septic shock. Although there were no significant effects on patient prognoses, patients who were administered single-dose IVIG showed significantly improved IL-6 levels, blood lactate levels, and disease severity scores.
RESUMO
We, in the present study, studied the stability, operability, and economy as a whole of NT-proBNP assay, and further on the performance of diagnosing cardiac failure as a laboratory test. It was found to be superior to BNP assay not only as a reagent but also as a clinical test to diagnose cardiac functions. On the other hand, it is reported that NT-proBNP is influenced by the renal function more than BNP, and we investigated it precisely. As a result, NT-proBNP was equally influenced as BNP when the estimated glomerular filtration rate (eGFR) was more than 60 ml/min. When eGFR decreased further, BNP was also increased by the decreased renal clearance. Thereby, NT-proBNP was increased relatively more than BNP because BNP was catabolized by other mechanisms than renal clearance. Therefore, NT-proBNP may be superior to BNP in regard to estimate secretion of BNP from the heart particularly when renal function was decreased. In conclusion, NT-proBNP is an excellent biomarker to diagnose heart failure.
