***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Introduction In this prospect i ve , r and omized controlled study , we aim ed to evaluate the effect of IgM-enriched immunoglobulin treatment on progression of organ failure and septic shock in patients with severe sepsis . Material s and methods Forty-two patients with severe sepsis were enrolled in the study . Patients in the study group ( n = 21 ) received an intravenous immunoglobulin preparation ( Pentaglobin ® ) in addition to st and ard therapy . Pentaglobin ® therapy was commenced on the day of diagnosis of severe sepsis : 5 ml/kg per day Pentaglobin ® ( 38 g/l IgG , 6 g/l IgM , and 6 g/l IgA ) was infused over 6 hours and repeated for 3 consecutive days . Patients in the control group ( n = 18 ) received st and ard sepsis therapy , but no immunoglobulin administration . Blood sample s for procalcitonin ( PCT ) measurements were taken daily for 8 days . Severity of critical illness and development of organ failure were assessed by obtaining daily acute physiological and chronic health evaluation ( APACHE ) II and sequential organ failure assessment ( SOFA ) scores . Results and discussion Procalcitonin levels showed a statistically significant decrease in the Pentaglobin ® group ( P < 0.001 ) ; however , an improvement in SOFA scores could not be demonstrated . Procalcitonin levels and SOFA scores did not change significantly in the control group . Septic shock incidence ( 38 % versus 57 % ) and 28-day mortality rate ( 23.8 % versus 33.3 % ) were found to be similar between the Pentaglobin ® and control groups . The evaluation of serial APACHE II scores did not demonstrate a difference between Pentaglobin ® and control groups either . Conclusion Present data could not demonstrate any beneficial effects of polyclonal immunoglobulin preparation Pentaglobin ® on organ morbidity , septic shock incidence and mortality rate in patients with severe sepsis 35 patients with septic postoperative complications entered a prospect ively r and omized study . The clinical state of these patients was daily determined using the sepsis score described by Elebute and Stoner . Endotoxin and antithrombin III were measured in the plasma using the limulus-amoebocyte-lysat test for endotoxin determination . The septic patients were treated with an immunoglobulin preparation ( Pentaglobin ) administered by the intravenous route . This preparation is enriched in IgM and IgA. Due to the immunoglobulin therapy the endotoxin titres decreased ; simultaneously a reduction of mortality and shortening of time of hospitalization and of mechanical ventilation were observed BACKGROUND It remains uncertain whether the choice of resuscitation fluid for patients in intensive care units ( ICUs ) affects survival . We conducted a multicenter , r and omized , double-blind trial to compare the effect of fluid resuscitation with albumin or saline on mortality in a heterogeneous population of patients in the ICU . METHODS We r and omly assigned patients who had been admitted to the ICU to receive either 4 percent albumin or normal saline for intravascular-fluid resuscitation during the next 28 days . The primary outcome measure was death from any cause during the 28-day period after r and omization . RESULTS Of the 6997 patients who underwent r and omization , 3497 were assigned to receive albumin and 3500 to receive saline ;  the two groups had similar baseline characteristics . There were 726 deaths in the albumin group , as compared with 729 deaths in the saline group ( relative risk of death , 0.99 ; 95 percent confidence interval , 0.91 to 1.09 ; P=0.87 ) . The proportion of patients with new single-organ and multiple-organ failure was similar in the two groups ( P=0.85 ) . There were no significant differences between the groups in the mean ( + /-SD ) numbers of days spent in the ICU ( 6.5+/-6.6 in the albumin group and 6.2+/-6.2 in the saline group , P=0.44 ) , days spent in the hospital ( 15.3+/-9.6 and 15.6+/-9.6 , respectively ; P=0.30 ) , days of mechanical ventilation ( 4.5+/-6.1 and 4.3+/-5.7 , respectively ; P=0.74 ) , or days of renal-replacement therapy ( 0.5+/-2.3 and 0.4+/-2.0 , respectively ; P=0.41 ) . CONCLUSIONS In patients in the ICU , use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days Objective : To evaluate the effect of intravenous IgMA-enriched immunoglobulin ( ivIGMA ) therapy on mortality in neutropenic patients with hematologic malignancies and sepsis syndrome or septic shock . Design : Multiple-center , prospect i ve r and omized , controlled study . Setting : Six university hospitals in Germany . Patients : Patients were 211 neutropenic patients with sepsis syndrome or septic shock after chemotherapy for severe hematologic disorders between 1992 and 1999 . Interventions : Patients received 1300 mL of ivIGMA ( 7.8 g IgM , 7.8 g IgA , and 49.4 g IgG ) infused intravenously within a period of 72 hrs or human albumin according to the same schedule as ivIGMA . Measurements and Main Results : All-cause mortality at 28 days , sepsis-related mortality at 28 days , all-cause mortality at 60 days , mortality from septic shock , and mortality from microbiologically proven Gram-negative sepsis and septic shock were recorded . Immunoglobulin had no benefit over human albumin . The 28-day mortality rate was 26.2 % and 28.2 % in the ivIGMA and control patients , respectively ( difference , 2.0 % [ 95 % confidence interval , −10.2 to 14.2 percentage points ] ) . Likewise , the 60-day mortality rate did not differ between both arms ( 29.6 % vs. 34.7 % in the ivIGMA and control patients , respectively ) . Mortality rates in patients with sepsis syndrome ( 17.1 % vs. 16.7 % ) and septic shock ( 51.9 % vs. 54.8 % ) were also found to be similar between both groups . Conclusions : Intravenous ivIGMA had no beneficial effects in neutropenic patients with hematologic malignancies and sepsis syndrome and septic shock Thrombocytopenia frequently complicates systemic infection and results from multiple possible mechanisms . We and others have demonstrated that platelet-associated IgG ( PAIgG ) levels are elevated in the majority of patients with septic thrombocytopenia .  Corticosteroids may be undesirable as a treatment for thrombocytopenia for patients with severe infection because of their potential for suppressing the immune response . We hypothesized that septic thrombocytopenia is , in most cases , an immune disorder analogous to idiopathic thrombocytopenic purpura ( ITP ) which might respond to intravenous gamma-globulin as a treatment for increasing the platelet count in this disorder . Intravenous immune globulin ( IVIG ) , 400 mg/kg daily for 3 days , was administered in a r and omized double-blind placebo-controlled trial . Twenty-nine patients who developed thrombocytopenia during a documented , septic episode were studied . Patients with disseminated intravascular coagulation ( DIC ) , hypersplenism , or drugs known to cause thrombocytopenia were excluded . Elevated PAIgG levels were documented in 52 % of evaluable patients . Mean platelet counts in the IVIG group rose from 43 K at study entry to 178 K ( 411 % rise ) by Day 9 . In the placebo group platelets rose from 51 K to 125 K ( 261 % rise;P = 0.02 ) . Seventy-seven percent of the IVIG group had a minimum peak rise of 35 K , vs 56 % of the placebo group . Three patients in the placebo group had a serious bleeding episode , vs one in the IVIG group . The use of IVIG to treat septic thrombocytopenia not associated with DIC leads to a more rapid , more sustained , and greater increase in platelet count than placebo . Its use is recommended in the septic patient who is bleeding or is likely to need invasive or surgical procedures The objective of this study was to assess the impact on outcome of adjuvant therapy ( high-dose of immunoglobulin [ Ig ] M-enriched intravenous Ig , IVIG ) in intensive care unit ( ICU ) patients who underwent surgery by abdominal sepsis . This was a prospect i ve , r and omized , double-blind , controlled study set in the medical/surgical ICUs of seven teaching hospitals . Patients with severe sepsis and septic shock of intra-abdominal origin admitted to the ICU within 24 h after the onset of symptoms were included in the study . Polyvalent IgM-enriched Ig ( Pentaglobin ® ; IVIG group ) at a dosage of 7 mL/kg/day for 5 days or an equal amount of 5 % human albumin ( control group ) was r and omized . Fifty-six patients were enrolled . The overall mortality rate was 37.5.% . Twenty patients had shock and 36 had severe sepsis ( the mortality rate was 55.0 % and 25.0 % , respectively ) . In the intent-to-treat analysis , the mortality rate was reduced from 48.1 % in patients treated with antibiotic ( ATB ) plus albumin to 27.5 % ( P = 0.06 ) for patients with ATB plus IVIG . The organ failure score ( 1.0 ± 0.6 vs. 1.2 ± 0.9 ) , organ dysfunction score ( 1.7 ± 1.1 vs. 1.8 ± 1.0 ) , and reoperation rate ( 17.2 % vs. 29.6 % ) were not different between IVIG and control groups , respectively . Eight patients ( 14.3 % ) received inappropriate ATB initial therapy ( IAT ) , and seven died ( 87.5 % ) . IAT was the only variable independently associated with death ( odds ratio , 19.4 ) in a logistic regression model . We conclude that IVIG administration , when used in combination with adequate antibiotics , improved the survival of surgical ICU patients with intra-abdominal sepsis . The initial choice of antibiotic has a dramatic impact on outcome The efficacy and safety of high-dose intravenous polyspecific immunoglobulin G ( IVIG ) as adjunctive therapy in streptococcal toxic shock syndrome ( STSS ) were evaluated in a multicenter , r and omized , double-blind , placebo-controlled trial . The trial was prematurely terminated because of slow patient recruitment , and results were obtained from 21 enrolled patients ( 10 IVIG recipients and 11 placebo recipients ) . The primary end point was mortality at 28 days , and a 3.6-fold higher mortality rate was found in the placebo group . A significant decrease in the sepsis-related organ failure assessment score at days 2 ( P=.02 ) and 3 ( P=.04 ) was noted in the IVIG group . Furthermore , a significant increase in plasma neutralizing activity against superantigens expressed by autologous isolates was noted in the IVIG group after treatment ( P=.03 ) . Although statistical significance was not reached in the primary end point , the trial provides further support for IVIG as an efficacious adjunctive therapy in STSS Summary A multicenter r and omized controlled clinical trial , which was carried out in 10 hospitals in the Federal Republic of Germany between 1979 and 1983 , studied the influence of i.v . immunoglobulin G on the mortality in patients with diffuse acute fibrinopurulent peritonitis . Altogether 288 patients were enrolled in the trial . There was no statistically significant difference in the mortality rates within the treated group ( 46 % ) vs the control group ( 41 % ) . The power of the statistical test to detect a decrease of the mortality by 20 % was calculated to be 0.93 . This result did not change when we eliminated 50 patients not strictly obeying the entrance criteria of the analysis , or when we focused on a subgroup of patients with initial deficiency of immunoglobulin G. Factors influencing mortality were a preceding laparotomy , serum creatinine level above 2 mg/100 ml , and necessity for artificial respiration . These factors , reflecting the surgical situation and the severity of shock , essentially explain the mortality differences observed between the participating hospitals Sixty-two consecutive septic surgical patients receiving st and ard multimodal intensive care unit treatment who developed a sepsis score of 20 or greater ( day 0 ) were r and omized to receive 0.4 g/kg of either intravenous IgG ( 29 patients ) or human albumin ( controls  ;  33 patients ) , repeated on days + 1 and + 5 , in a prospect i ve , double-blind , multicenter study . The two groups were similar in age , initial sepsis scores , and acute physiology and chronic health evaluation II score . A significantly lower mortality was recorded in the IgG-treated group ( 38 % ) than in controls ( 67 % ) . Septic shock was the cause of death in 7 % of IgG-treated patients and in 33 % of controls . The results of this study indicate that high 
    Output:
    
This meta- analysis demonstrates an overall reduction in mortality with the use of ivIg for the adjunctive treatment of severe sepsis and septic shock in adults , although significant heterogeneity exists among the included trials and this result was not confirmed when only high- quality studies were analyzed .