PubMed database, EMBase, Cochrane clinical trial database, CNKI, and Wangfang database etc were retrieved. The search time was from database creation to September 2015,which included all prospective studies of the effectiveness of
IVIG compared with non-
IVIG in all adult patients with
severe sepsis. Main end-point parameter was total mortality rate; secondary end-point parameters were short-term (< 7 days) mortality,28-day mortality, length of intensive care unit (ICU) and
hospital stay, and mortality due to
septic shock or
multiple organ failure (MOF). RevMan 5.3 was used for Meta analysis.
Results: Finally,16 prospective studies including 12 randomized controlled trails (RCT) and 4 prospective cohort studies were enrolled, referred to 1 819 patients, 892 patients were in
IVIG group, 927 patients receiving
human albumin, placebo or blank control were in control group. Compared with the control group,
IVIG could reduce the total mortality rate of patients with
severe sepsis [relative risk (RR) =0.71,95% confidence interval (95%CI) =0.57-0.87,P =0.001].After the high-risk research was eliminated, it was shown that the
IVIG could reduce the total mortality rate in patients with
severe sepsis (RR =0.80, 95%CI =0.65-0.98, P =0.03).But
IVIG could not reduce the 28-day mortality rate (RR =0.60, 95%CI =0.35-1.04, P =0.07), short-term mortality rate (RR =1.06, 95%CI =0.76-1.46,P =0.74), the mortality rate of
septic shock (RR =0.55, 95%CI =0.29-1.03, P =0.06) and the mortality rate of MOF (RR =0.91, 95%CI =0.63-1.33, P =0.64).In fact, the
length of stay in ICU [weighted mean difference (WMD) =-0.02, 95%CI =-0.03-0.25, P =0.86] and the total
length of stay in hospital (WMD =-2.34,95%CI =-7.05-2.37,P =0.33) were similar. In subgroup, the 28-day mortality rate of patients with
severe sepsis in the
IgM group (RR =0.50, 95%CI =0.25-1.01, P =0.05) was significantly lower than that of
IgG group (RR =0.72, 95%CI =0.40-1.30, P =0.28).
Conclusions:
IVIG can reduce the total mortality rate of patients with
severe sepsis. Compared with
IgG,
IgM-enriched
IVIG has certain advantages in patients with
severe sepsis, but cannot reduce the short-term mortality rate, mortality rate of
septic shock and MOF, and also cannot shorten the length of ICU stay and the total length of hospital day.