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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

A Novel Scoring System for the Administration of an IgM- and IgA-Enriched Intravenous Immunoglobulin Preparation: The SORRISO Score

by
Mattia Bixio
1,
Lucio Torelli
2,
Alice Scamperle
3,
Giada Quarantotto
4,
Silvia Zanchi
3,
Silvia Baronio
3,
Lucia Mirabella
5,
Alessandro Conti
6,
Francesco Forfori
7,
Alberto Noto
8,
Valeria Bonato
9,
Andrea Cortegiani
10,11,
Eugenia Botter
3,
Antonino Chillemi
3,
Irene Longo
3,
Roberto Dattola
3 and
Giorgio Berlot
3,*
1
UO Anestesia e Rianimazione, Ospedale Policlinico San Martino, 16132 Genova, Italy
2
Dipartimento Universitario di Scienze Mediche, Chirurgiche e della Salute, Università di Trieste, 34129 Trieste, Italy
3
Department of Anesthesia, Intensive Care and Pain Therapy, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy
4
Department of Anesthesia and Intensive Care, Pordenone Hospital, 33170 Pordenone, Italy
5
Anesthesia and Intensive Care, Department of Medical and Surgical Science, University of Foggia, 71121 Foggia, Italy
6
UO di Rianimazione, Ospedale San Marco, 95121 Catania, Italy
7
Dipartimento di Patologia Chirurgica Medica Molecolare e dell’Area Critica, Università di Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
8
Division of Anesthesia and Critical Care, Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy
9
SS Terapia Intensiva Polivalente Anestesia e Rianimazione, Azienda Ospedaliera Universitaria SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
10
Department of Precision Medicine in Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy
11
General Intensive Care Unit, Policlinico Paolo Giaccone, 90127 Palermo, Italy
 
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Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(17), 5950; https://doi.org/10.3390/jcm14175950
Submission received: 21 July 2025 / Revised: 12 August 2025 / Accepted: 18 August 2025 / Published: 22 August 2025
(This article belongs to the Section Intensive Care)
Versions Notes

Abstract

Background/Objectives: The use of intravenous immunoglobulins enriched with IgA and IgM (eIg) in patients with septic shock remains controversial due to a lack of robust, standardized criteria for patient selection and the timing of treatment. This study introduces the SORRISO Score, which is a novel, evidence-informed scoring system designed to guide clinical decision-making for the administration of eIg. Methods: Based on data from the Italian multicentric SORRISO registry, involving 248 patients across seven ICUs from 2015 to 2022, the score integrates patient-related and therapy-related variables. These were derived through an enhanced version of the TO-PIRO Score and include factors such as immunosuppressive status, infection type, timing of treatment, and adequacy of antibiotic therapy. Results: Statistical analyses, including Kaplan–Meier curves and regression models, identified the key predictors of survival and validated the score’s ability to stratify patients by outcome. A cutoff of 13.7 showed a significant prognostic value (AUC = 0.731), with lower scores correlating with increased mortality. Conclusions: The SORRISO Score thus offers a practical bedside tool for improving patient selection for eIg therapy, potentially optimizing outcomes in septic shock; however, it should be validated in a larger cohort of patients.
Keywords: septic shock; intravenous immunoglobulins enriched with IgA and IgM (eIg); SORRISO Score; patient stratification; early treatment; antibiotic adequacy; immunosuppression septic shock; intravenous immunoglobulins enriched with IgA and IgM (eIg); SORRISO Score; patient stratification; early treatment; antibiotic adequacy; immunosuppression

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MDPI and ACS Style

Bixio, M.; Torelli, L.; Scamperle, A.; Quarantotto, G.; Zanchi, S.; Baronio, S.; Mirabella, L.; Conti, A.; Forfori, F.; Noto, A.; et al. A Novel Scoring System for the Administration of an IgM- and IgA-Enriched Intravenous Immunoglobulin Preparation: The SORRISO Score. J. Clin. Med. 2025, 14, 5950. https://doi.org/10.3390/jcm14175950

AMA Style

Bixio M, Torelli L, Scamperle A, Quarantotto G, Zanchi S, Baronio S, Mirabella L, Conti A, Forfori F, Noto A, et al. A Novel Scoring System for the Administration of an IgM- and IgA-Enriched Intravenous Immunoglobulin Preparation: The SORRISO Score. Journal of Clinical Medicine. 2025; 14(17):5950. https://doi.org/10.3390/jcm14175950

Chicago/Turabian Style

Bixio, Mattia, Lucio Torelli, Alice Scamperle, Giada Quarantotto, Silvia Zanchi, Silvia Baronio, Lucia Mirabella, Alessandro Conti, Francesco Forfori, Alberto Noto, and et al. 2025. "A Novel Scoring System for the Administration of an IgM- and IgA-Enriched Intravenous Immunoglobulin Preparation: The SORRISO Score" Journal of Clinical Medicine 14, no. 17: 5950. https://doi.org/10.3390/jcm14175950

APA Style

Bixio, M., Torelli, L., Scamperle, A., Quarantotto, G., Zanchi, S., Baronio, S., Mirabella, L., Conti, A., Forfori, F., Noto, A., Bonato, V., Cortegiani, A., Botter, E., Chillemi, A., Longo, I., Dattola, R., & Berlot, G. (2025). A Novel Scoring System for the Administration of an IgM- and IgA-Enriched Intravenous Immunoglobulin Preparation: The SORRISO Score. Journal of Clinical Medicine, 14(17), 5950. https://doi.org/10.3390/jcm14175950

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