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Impact of immunomodulating therapy on morbidity in patients with severe sepsis

Reinhart, K.
Leighton, A.
Barker, C.
Macdonald, F.
Abraham, E.
Published in American journal of respiratory and critical care medicine. 1999, vol. 160, no. 3, p. 852-857
Abstract We assessed the impact, over a 28-d period, of therapy with the tumor necrosis factor (TNF) neutralizing receptor fusion protein (p55-IgG) on the incidence of end-organ failures in patients with severe sepsis or early septic shock in a subgroup of 165 patients recruited into a randomized, multicenter clinical trial to receive placebo (n = 78) or a single infusion of p55-IgG, 0.083 mg/kg (n = 87). At study entry, distribution of organ dysfunctions and other baseline characteristics were similar for the two study groups. Treatment with p55-IgG was associated with a trend toward reduced 28-d mortality (p = 0.07), a decreased incidence of new organ dysfunctions (relative risk [RR], 0.57; 95% confidence interval [95% CI] 0.29 to 1.10, p = 0.10), and a decreased overall incidence-density of organ failures (RR 0.65; 95% CI 0.60 to 0.71, p = 0.0001). Patients treated with p55-IgG had more organ failure-free days after study entry than those who received placebo. Average intensive care unit (ICU) stay was 2.6 d shorter (95% CI 0.2 to 5.0) for patients who received p55-IgG than for those who received placebo. For those patients who survived, this difference was 4.1 d (95% CI 1.6 to 6.6). Duration of ventilatory support was 3.2 d shorter (95% CI 0.1 to 6.3) among 28-d survivors who received p55-IgG, compared with placebo. In conclusion, in the population of septic patients studied, treatment with p55-IgG was associated with a trend toward shorter need for mechanical ventilatory support, a decreased length of stay (LOS), and a decreased incidence and duration of organ failure.
Keywords ApacheAdultChi-Square DistributionDouble-Blind MethodFemaleHumansImmunoglobulin G/ therapeutic useImmunoglobulin Heavy ChainsImmunoglobulin gamma-ChainsLength of Stay/statistics & numerical dataMaleMultiple Organ FailureProspective StudiesReceptors, Tumor Necrosis Factor/ therapeutic useRecombinant Fusion Proteins/therapeutic useSepsis/ drug therapy/physiopathologyShock, Septic/drug therapy/physiopathologySurvival AnalysisTumor Necrosis Factor-alpha/ antagonists & inhibitors
PMID: 10471608
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Other version: http://ajrccm.atsjournals.org/cgi/reprint/160/3/852.pdf
Research groups Epidémiologie et contrôle de la résistance aux antibiotiques (866)
Staphylocoques dorés résistants à la méthicilline et hygiène hospitalière (330)
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PITTET, Didier et al. Impact of immunomodulating therapy on morbidity in patients with severe sepsis. In: American journal of respiratory and critical care medicine, 1999, vol. 160, n° 3, p. 852-857. https://archive-ouverte.unige.ch/unige:7504

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Deposited on : 2010-06-21

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