Prognostic value of circulating lymphocyte B and plasma immunoglobulin M on septic shock and sepsis: a systematic review and meta-analysis

Objective: Normal B lymphocyte function and antibody secretion during inflammation can provide critical protection for the host. We aimed to synthesize existing evidence to explore whether circulating B cells and plasma immunoglobulin M (IgM) levels were associated with survival during sepsis. Methods: PubMed, Embase, ISI Web of Knowledge, Cochrane Central Register of Controlled Trials were systematically searched. Studies with data on circulating B cells and plasma IgM levels within the initial 24 hours after sepsis onset were selected. Results: A total of 11 studies were qualified for inclusion in this systematic review and meta-analysis with a total of 829 patients with sepsis and/or septic shock. Number of circulating B cells was similar between septic patients and health controls (SMD = -1.81, 95% CI: -4.15, 0.54; P = 0.13, I-2 = 99%), while it was significantly reduced in sepsis survivors versus sepsis non-survivors (SMD = -0.60, 95% CI: -0.87, -0.32; P < 0.0001, I-2 = 0%). Concentration of plasma IgM level was significantly decreased in septic patients as compared with healthy controls. Also, the plasma IgM level was significantly lower in sepsis survivors versus sepsis non-survivors. Conclusions: A poor prognostic survival outcome was observed for patients with decreased circulating B cells as well as IgM levels within the initial 24 h after sepsis onset.