Timing IgM Treatment in Sepsis: Is Procalcitonin the Answer?

Modern intensive care therapy could, with a small stretch of the imagination, be argued to equal severe sepsis and septic shock therapy. This does not mean that every patient on the intensive care unit (ICU) is septic, but every critically ill patient certainly has the potential risk of acquiring sepsis. Furthermore, almost everything that we know today about critical illness is somehow linked to what we have learned from experimental and clinical sepsis studies. However, after decades of intense research we are still struggling to improve mortality on our ICUs, although there is a tendency towards some improvement (from 37 to 30.7 %) [1, 2]. So, is it ‘much ado about nothing’? Absolutely not! The devil, as always, lies in the details. We keep forgetting that what we call ‘sepsis’ is not a definitive disease, or diagnosis, but a syndrome, for which the criteria were defined by consensus by a group of scientists led by the late Roger Bone in a Las Vegas hotel room back in the 1980s, and a few years later on at a consensus conference [3–5]. In the case of definitive conditions such as, for example, fractured neck of femur or myocardial infarction, we have specific tools for diagnosis, and treatment. Unfortunately, this is not the case for sepsis. There is no exact diagnostic measure to capture the moment when systemic inflammatory response syndrome (SIRS), infection, sepsis, severe sepsis or septic shock occurs, nor to precisely differentiate between them. This uncertainty will inevitably lead to inhomogeneous groups of patients with selection bias, sampling error in our studies, and eventually failure to produce significant results [6–8].