Hippokratia 1997, 1(2):83-92
H. Makriyiannaki, K. Chatzinikolaou, H. Vagdatli, E. Fragopoulou, C. Tsiotras, M. Economou
In the present pilot study recombinant human Granulocyte Colony Stimulating Factor (rh G-CSF) was adjunctively administered in septic ICU patients with severe structural abnormalities of their Polymorfonuclear Leucocytes (PMNL) and a phagocytic activity (NBT-test) lower than 50% of the normal value. The drug was administered subcutaneously in a dose of 0.5 IU (5 µg)/kg B.W. / day until the phagocytic activity of the circulating PMNL increased over 80%. This was done after 3-12 days (median 5) of administration. The following changes (means ? SD) have been occurred during rh G-CSF administration: The number and the phagocytic activity of the circulating PMNL increased significantly from 13.454 ? 7.158?109/L and 34 ? 15% to 31.987 ? 16.150 ?109/L and 81 ? 6% respectively (p < 0.001), while the morphological picture of the peripheral PMNL experienced a drastic improvement. Platelets number increased from 122 ? 30.7 to 220 ? 45,25 ? 109/L (p < 0.001). Cardiac index decreased significantly from 4.9 ? 1,9 to 3,4 ? 0,6 L/min/m2 (p < 0.001) and systemic vascular resistance increased significantly from 642 ? 141 to 1034 ? 220 dyn.sec.cm-5 (p < 0.001). The APACHE II score decreased from 21,5 ? 1,8 to 16,2 ? 4,5 (p < 0.001), due to regression of fever, tachycardia, hypotensive episodes and hypernatremia. The serum iron concentration raised from 40 ? 10.6 to 82 ? 22 µg/dL (p < 0.001). These changes indicate a limitation of the inflammatory process. It is concluded that the hematopoietic growth factor G-CSF reverses the structural and functional derangements of the PMNL in critically ill patients. This effect may imply a limitation of the infectious stimulus and hereby the host's inflammatory response, contributing to reduction of hospitalization and mortality in septic patients. A prospective randomized clinical trial could show the impact of adjunctive G-CSF therapy on the outcome of these septic patients.