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. 2025 Aug 22;14(17):5950.
doi: 10.3390/jcm14175950.

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

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 , Giorgio Berlot  3
Affiliations

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

Mattia Bixio et al. J Clin Med. .

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: SORRISO Score; antibiotic adequacy; early treatment; immunosuppression; intravenous immunoglobulins enriched with IgA and IgM (eIg); patient stratification; septic shock.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure A1
Figure A1
Kaplan–Meier curve for P1_TOPIRO (revised): any cancer vs. no cancer.
Figure A2
Figure A2
Kaplan–Meier curve for P3_TOPIRO (revised): Neutropenia or immunosuppressive drugs (monoclonal/steroids/mycophenolate/cyclosporin) or allogenic stem cell transplant or splenectomy or AIDS vs. none.
Figure A3
Figure A3
Kaplan–Meier curve for type of admission: surgical vs. medical.
Figure A4
Figure A4
Kaplan–Meier curve for site of infection: abdomen vs. others.
Figure A5
Figure A5
Kaplan–Meier curve for I3_TOPIRO: Secondary/tertiary peritonitis vs. none.
Figure A6
Figure A6
Kaplan–Meier curve for positive culture isolation: Gram-negative bacteria vs. none.
Figure A7
Figure A7
Kaplan–Meier curve for I2_TOPIRO: MDR infections or nosocomial infections.
Figure A8
Figure A8
Kaplan–Meier curve for R5_TOPIRO (revised): Disseminated intravascular coagulation vs. none.
Figure A9
Figure A9
Kaplan–Meier curve for SAPSII Score: under 50 vs. over 50.
Figure A10
Figure A10
Kaplan–Meier curve for timing of eIg infusion (72 h): early vs. late.
Figure A11
Figure A11
Kaplan–Meier curve for adequacy of antibiotic therapy: yes vs. no.
Figure 1
Figure 1
Timeline of the SORRISO study.
Figure 2
Figure 2
Estimated marginal means (SORRISO Score).
Figure 3
Figure 3
Kaplan–Meier curve for patients with scores above or below the cutoff.
See this image and copyright information in PMC

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