• Mar Justel, Lorenzo Socias, Raquel Almansa, Paula Ramírez, Maria C Gallegos, Victoria Fernandez, Monica Gordon, David Andaluz-Ojeda, Leonor Nogales, Silvia Rojo, Jordi Vallés, Angel Estella, Ana Loza, Cristobal León, Cristina Lopez-Mestanza, Jesús Blanco, Jose Ángel Berezo, Sara Rosich, Catia Cillòniz, Antoni Torres, Raul Ortiz de Lejarazu, Ignacio Martin-Loeches, and Jesus F Bermejo-Martin.
• Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, SACYL, Avda Ramón y Cajal 3, 47005 Valladolid, Spain(2).
• J. Clin. Virol. 2013 Nov 1;58(3):564-7.

BackgroundLittle is known on the participation of immunoglobulin isotypes and subclasses in the pathogenesis of the severe disease caused by the pandemic influenza virus (influenza A(H1N1)pdm09).Objectives(1) To evaluate the association between plasma levels of IgG1, IgG2, IgG3, IgG4, IgA, IgM, IgE and outcome in patients with severe pandemic influenza. (2) To evaluate the association between immunoglobulin and cytokine levels in these patients.Study Design40 critically ill patients with community acquired pneumonia and influenza A(H1N1)pdm09 infection were recruited from November 2010 to February 2011. Plasma samples were collected during the first 24h following admission to the ICU. Immunoglobulins and 17 major cytokines were profiled in plasma.Results15 patients died (37.5%). When the association between clinical variables and prognosis was assessed, prior immunosuppression, APACHE II score, levels of IgG2 and levels of IgM were associated with outcome in a univariate Cox regression analysis. Kaplan Meier analysis showed that patients with levels of IgG2 and IgM < 59 and<58 mg/dl respectively died earlier. Multivariate Cox regression analysis showed that APACHE II score and levels of IgM were the best predictors of outcome, being levels of IgM a protective factor against mortality. IgM was the immunoglobulin showing the largest number of negative correlations with cytokine levels.ConclusionsOur results support a central role of IgM in preventing uncontrolled inflammatory response and mortality in severe pandemic influenza. Early assessment of IgM could contribute to guide clinical decisions in these patients.Copyright © 2013 Elsevier B.V. All rights reserved.

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