Difference in the responses after administration of granulocyte colony-stimulating factor in septic patients with relative neutropenia.
OBJECTIVE
The objective of this study was to classify the clinical responses after administration of granulocyte colony-stimulating factor (G-CSF) in septic patients with relative neutropenia.


METHODS
We administered recombinant human G-CSF (2 microg/kg) subcutaneously once a day for 5 days to 30 septic patients with white cell counts below 5,000 cells/mm3. Absolute neutrophil count (ANC), neutrophil differentiation, and serum concentration of G-CSF were determined serially. Bone marrow also was analyzed before and after treatment.


RESULTS
Neutrophil responses to G-CSF varied from good (ANC > 10,000/mm3, group G, n = 20) to moderate (ANC < 10,000/mm3, group M, n = 5) to poor (no increase in ANC, group P, n = 5). Before G-CSF administration, the three groups showed no differences in ANC but did show significant differences in serum concentration of G-CSF. G-CSF concentration was 0.16 +/- 0.03 ng/mL in group G, 7.0 +/- 3.0 ng/mL in group M, and 270 +/- 90 ng/mL in group P. Immature neutrophils accounted for 35.0 +/- 3.7% of peripheral leukocytes in group P but only 5.1 +/- 0.6% in group G. Although bone marrow was depressed in all groups before G-CSF treatment, nucleated cell count increased significantly after rhG-CSF treatment in groups G and M. Survival rate after 4 weeks was 90% in group G and 100% in group M; no patient in group P survived.


CONCLUSIONS
G-CSF administration was effective in septic patients with a low percentage of immature neutrophils and insufficient endogenous G-CSF. It had little effect on patients with a high percentage of immature neutrophils whose G-CSF production was up-regulated and whose bone marrow was severely depressed.
Ishikawa
K
K
Department of Traumatology, Osaka University Medical School, Japan.
Tanaka
H
H
Nakamori
Y
Y
Hosotsubo
H
H
Ogura
H
H
Nishino
M
M
Shimazu
T
T
Sugimoto
H
H
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000209:etiology; D016207:Cytokines / Q000097:blood / Q000187:drug effects; D016903:Drug Monitoring; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D007279:Injections, Subcutaneous; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000187:drug effects; D009102:Multiple Organ Failure / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D009503:Neutropenia / Q000097:blood / Q000209:etiology* / Q000276:immunology; D009504:Neutrophils / Q000187:drug effects; D011379:Prognosis; D011994:Recombinant Proteins; D018805:Sepsis / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis
D016207:Cytokines; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor