Plasma granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor levels in critical illness including sepsis and septic shock: relation to disease severity, multiple organ dysfunction, and mortality.
OBJECTIVE
To define the circulating levels of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) during critical illness and to determine their relationship to the severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the development of multiple organ dysfunction, or mortality.


METHODS
Prospective cohort study.


METHODS
University hospital intensive care unit.


METHODS
A total of 82 critically ill adult patients in four clinically defined groups, namely septic shock (n = 29), sepsis without shock (n = 17), shock without sepsis (n = 22), and nonseptic, nonshock controls (n = 14).


METHODS
None.


RESULTS
During day 1 of septic shock, peak plasma levels of G-CSF, interleukin (IL)-6, and leukemia inhibitory factor (LIF), but not GM-CSF, were greater than in sepsis or shock alone (p < .001), and were correlated among themselves (rs = 0.44-0.77; p < .02) and with the APACHE II score (rs = 0.25-0.40; p = .03 to .18). G-CSF, IL-6, and UF, and sepsis, shock, septic shock, and APACHE II scores were strongly associated with organ dysfunction or 5-day mortality by univariate analysis. However, multiple logistic regression analysis showed that only septic shock remained significantly associated with organ dysfunction and only APACHE II scores and shock with 5-day mortality. Similarly, peak G-CSF, IL-6, and LIF were poorly predictive of 30-day mortality.


CONCLUSIONS
Plasma levels of G-CSF, IL-6, and LIF are greatly elevated in critical illness, including septic shock, and are correlated with one another and with the severity of illness. However, they are not independently predictive of mortality, or the development of multiple organ dysfunction. GM-CSF was rarely elevated, suggesting different roles for G-CSF and GM-CSF in human septic shock.
Presneill
J J
JJ
Intensive Care Unit, The Royal Melbourne Hospital, Victoria, Australia.
Waring
P M
PM
Layton
J E
JE
Maher
D W
DW
Cebon
J
J
Harley
N S
NS
Wilson
J W
JW
Cade
J F
JF
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000097:blood*; D006131:Growth Inhibitors / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D053605:Leukemia Inhibitory Factor; D016015:Logistic Models; D008222:Lymphokines / Q000097:blood; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000145:classification / Q000150:complications / Q000401:mortality; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000145:classification / Q000150:complications / Q000401:mortality
D006131:Growth Inhibitors; D015850:Interleukin-6; C507837:LIF protein, human; D053605:Leukemia Inhibitory Factor; D008222:Lymphokines; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor