Journal ArticleDOI
A Controlled Clinical Trial of E5 Murine Monoclonal IgM Antibody to Endotoxin in the Treatment of Gram-Negative Sepsis
R L Greenman,Roland M. H. Schein,M A Martin,Richard P. Wenzel,Neil R. MacIntyre,G Emmanuel,H Chmel,R B Kohler,Mary C. McCarthy,J Plouffe +9 more
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TLDR
Treatment with E5 antiendotoxin antibody appears safe and reduces mortality and enhances the resolution of organ failure among patients with gram-negative sepsis who are not in shock when treated.Abstract:
Objective. —To assess the efficacy of adjunctive monoclonal antibody antiendotoxin immunotherapy in patients with gram-negative sepsis. Design. —Double-blind, randomized, placebo-controlled trial. Setting. —Thirty-three university-affiliated centers, including Veterans Affairs, community, and municipal hospitals. Patients. —Hospitalized adults with signs of gram-negative infection and a systemic septic response. Intervention. —Patients were assigned to receive either 2 mg/kg of a murine monoclonal antibody directed against gram-negative endotoxin (E5) or placebo. A second infusion was administered 24 hours later. Main Outcome Measures. —Mortality over the 30-day study period, resolution of organ failures, and safety. Results. —Four hundred eighty-six patients were enrolled. Three hundred sixteen had confirmed gram-negative sepsis (54% bacteremic, 46% nonbacteremic). The survival difference was not statistically significant for all patients. Among patients with gram-negative sepsis who were not in shock at study entry (n = 137), E5 treatment resulted in significantly greater survival (relative risk, 2.3; P =.01). Resolution of individual organ failures was more frequent among these patients, occurring in 19 (54%) of 35 patients in the E5 group vs eight (30%) of 27 in the placebo group ( P =.05). Four reversible allergic reactions occurred among 247 patients (1.6%) receiving E5. No other toxicity was identified. Conclusions. —Treatment with E5 antiendotoxin antibody appears safe. It reduces mortality and enhances the resolution of organ failure among patients with gram-negative sepsis who are not in shock when treated. ( JAMA . 1991;266:1097-1102)read more
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Journal ArticleDOI
Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis
Roger C. Bone,Robert A. Balk,F. B. Cerra,R. P. Dellinger,A. M. Fein,William A. Knaus,Roland M. H. Schein,W. J. Sibbald +7 more
TL;DR: An American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae as mentioned in this paper.
Journal ArticleDOI
The Natural History of the Systemic Inflammatory Response Syndrome (SIRS): A Prospective Study
TL;DR: This prospective epidemiologic study of SIRS and related conditions provides the first evidence of a clinical progression from SirS to sepsis to severe sepsi and septic shock, and stepwise increases in mortality rates in the hierarchy.
Journal ArticleDOI
Multiple organ failure. Pathophysiology and potential future therapy.
TL;DR: The goals of this review are to integrate the vast amount of new information on the basic biology of MOF and to focus special attention on the potential therapeutic consequences of these recent advances in the authors' understanding of this complex and perplexing syndrome.
Journal ArticleDOI
Plasma Cytokine and Endotoxin Levels Correlate with Survival in Patients with the Sepsis Syndrome
TL;DR: Study of lipopolysaccharide and cytokine levels in 97 patients with the sepsis syndrome found a positive correlation between high levels of plasma TNF- and mortality, and implicate T NF- as an important mediator in sepsi.
Journal ArticleDOI
Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis.
Christian Brun-Buisson,Françoise Doyon,Jean Carlet,Pierre Dellamonica,François Gouin,Agnès Lepoutre,Jean-Christophe Mercier,Georges Offenstadt,Bernard Regnier +8 more
TL;DR: Patients with clinically suspected sepsis but without microbiological documentation and patients with documented infection share common risk factors and are at similarly high risk of death.
References
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