title: Plasma granulocyte colony-stimulating factor levels correlate with clinical outcomes in patients with acute lung injury.
abstract: OBJECTIVE
  To evaluate the association between plasma granulocyte colony-stimulating factor (G-CSF) levels and clinical outcomes including mortality in patients with acute lung injury (ALI), and to determine whether lower tidal volume ventilation was associated with a more rapid decrease in plasma G-CSF over time in patients with ALI.
  
  
  METHODS
  Retrospective measurement of G-CSF levels in plasma samples that were collected prospectively as part of a large multicenter clinical trial.
  
  
  METHODS
  Intensive care units in ten university centers.
  
  
  METHODS
  The study included 645 patients enrolled in the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Network trial of lower tidal volumes compared with traditional tidal volumes for ALI.
  
  
  RESULTS
  Baseline plasma levels of G-CSF were associated with an increased risk of death and a decrease in ventilator-free days and organ failure-free days in multivariate analyses controlling for ventilation strategy, age, and sex (Odds ratio death 1.2/log10 increment G-CSF, 95% confidence interval 1.01 to 1.4). Stratification of G-CSF levels into quartiles revealed a strong association between the highest levels of G-CSF and an increased risk of death and decreased ventilator-free days and organ failure-free days in multivariate analyses controlling for ventilation strategy, Acute Physiology and Chronic Health Evaluation III score, Pao2/Fio2 ratio, creatinine, and platelet count (p < 0.05). Subgroup multivariate analysis of patients with sepsis as their risk factor for ALI revealed a U-shaped association between mortality and G-CSF levels such that risk increased linearly from the second through fourth (highest) quartiles, yet also increased in the first (lowest) quartile. G-CSF levels decreased over time in both tidal volume groups, and there was no statistical difference in the extent of decrease between ventilator strategies.
  
  
  CONCLUSIONS
  In patients with ALI, plasma G-CSF levels are associated with morbidity and mortality, but these levels are not influenced by tidal volume strategy. In patients with sepsis-related ALI, a bimodal association between baseline plasma G-CSF levels and subsequent morbidity and mortality from this disease was found.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Fletcher Allen Health Care, University of Vermont, VT, USA. benjamin.suratt@uvm.edu
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Suratt
authors.forename: Mark D
authors.initials: MD
authors.lastname: Eisner
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Calfee
authors.forename: Jenna B
authors.initials: JB
authors.lastname: Allard
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Whittaker
authors.forename: Dustin T
authors.initials: DT
authors.lastname: Engelken
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Petty
authors.forename: Thomas
authors.initials: T
authors.lastname: Trimarchi
authors.forename: Lauren
authors.initials: L
authors.lastname: Gauthier
authors.forename: Polly E
authors.initials: PE
authors.lastname: Parsons
mesh_terms: D055371:Acute Lung Injury / Q000097:blood* / Q000401:mortality; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000401:mortality; D012189:Retrospective Studies
chemical_list: D016179:Granulocyte Colony-Stimulating Factor