Is there a place for granulocyte colony-stimulating factor in non-neutropenic critically ill patients?
Immunoparalysis, characterised by impairments in neutrophil and monocyte/macrophage function, is common in critically ill patients. The theoretical ability of granulocyte colony-stimulating factor (G-CSF) to improve the functions of both neutrophils and monocytes/macrophages provides a rationale for G-CSF therapy in non-neutropenic critically ill patients with infection or a high risk of nosocomial infection. The expression of the receptors that mediate G-CSF effects in neutrophils and monocytes/macrophages is regulated by bacterial products, cytokines and endogenous G-CSF levels, accounting for the variables effects of G-CSF on the neutrophil functions of critically ill patients. This variability should be taken into account when designing studies on the use of G-CSF in ICU-patients. Studies are still needed to identify the subset of patients who may benefit from G-CSF therapy.
Intensive Care Unit, Saint Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France. elie.azoulay@sls.ap-hop-paris.fr
Elie
E
Azoulay
Christophe
C
Delclaux
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000818:Animals; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D016179:Granulocyte Colony-Stimulating Factor / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D007239:Infections / Q000188:drug therapy; D008264:Macrophages / Q000187:drug effects / Q000276:immunology; D009000:Monocytes / Q000187:drug effects / Q000276:immunology; D009503:Neutropenia / Q000150:complications; D009504:Neutrophils / Q000187:drug effects / Q000276:immunology; D018579:Patient Selection; D011014:Pneumonia / Q000188:drug therapy; D012449:Safety; D016896:Treatment Outcome
D000276:Adjuvants, Immunologic; D016179:Granulocyte Colony-Stimulating Factor