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

Serena Spanò; Gabriella Licitra; Giada Cucciolini; Etrusca Brogi; Rita Martinelli; Francesco Cundari; Maria Giovanna Curci; Federico Coccolini; Stefano Busani; Giorgio Berlot; Mattia Bixio; Gianni Biancofiore; Francesco Corradi; Francesco Forfori

doi:10.3390/jcm15041526

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

J Clin Med. 2026 Feb 14;15(4):1526. doi: 10.3390/jcm15041526.

Affiliations

¹ Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy.
² Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy.
³ General, Emergency and Trauma Surgery Department, Pisa University Hospital, 56100 Pisa, Italy.
⁴ Anesthesia and Intensive Care Department, University Hospital of Modena, University of Modena, 41125 Reggio Emilia, Italy.
⁵ Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino, 16132 Genova, Italy.
⁶ Department of Transplant Anesthesia and Critical Care, University School of Medicine, 56126 Pisa, Italy.

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.

Keywords: ICU; IgGAM (Pentaglobin®); IgM-enriched immunoglobulin; average treatment effect (ATE); eIg; mortality; propensity weighting score analysis; sepsis; sepsis dysfunction; septic shock; surgical patients.