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An audit of the use of granulocyte colony-stimulating factorin septic shock

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Background: Granulocyte colony-stimulating factor (G-CSF)stimulates the production of neutrophils and modulates the functionand activity of developing and mature neutrophils. In septic shock,the immune system can be considered one of the failing organ systems.G-CSF improves immune function and may be a useful adjunctive therapyin patients with septic shock.

Aim: To evaluate the introduction of G-CSF asan adjunct to our standard treatment for community-acquired septicshock.

Methods: We performed a prospective data collection andanalysis to determine whether the addition of G-CSF to our standardtreatment for community-acquired septic shock was associated withimproved hospital outcome, compared with an historical cohort ofsimilar patients. We included all patients admitted to the IntensiveCare Unit (ICU) with community-acquired septic shock between December1998 and March 2000. Patients received 300 µgG-CSF intravenously daily for 10 days in addition to ourstandard treatment for community-acquired septic shock. G-CSF wasdiscontinued early if the patient was discharged from ICU before10 days or if the absolute neutrophil count exceeded 75 × 106/mL.

Results: A total of 36 patients with community-acquiredseptic shock, an average Apache 2 score of 26.7, and a predictedmortality of 0.79, were treated with G-CSF from December 1998 toMarch 2000. Hospital mortality was 31% compared with anhistorical cohort of 11 similar patients with a hospital mortalityof 73% (P = 0.018). Inthe subgroup of patients with melioidosis septic shock, the hospitalsurvival improved from 5% to 100% (P < 0.0001).No significant adverse events occurred as a result of the administrationof G-CSF.

Conclusion: G-CSF is a safe adjunctive therapyin community-acquired septic shock and may be associated with improvedoutcome. The use of G-CSF in septic shock should undergo furtherinvestigation to define subgroups of patients who may benefit from G-CSF.The use of G-CSF in patients with septic shock due to Burkholderiapseudomallei is recommended. (Intern Med J 2002; 32: 143−148)

Keywords: Burkholderia pseudomallei; granulocytecolony-stimulating factor; melioidosis; mortality; septic shock

Document Type: Research Article


Affiliations: Royal Darwin Hospital, Tiwi, NorthernTerritory, Australia

Publication date: April 1, 2002


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