Document Detail


An audit of the use of granulocyte colony-stimulating factor in septic shock.
MedLine Citation:
PMID:  11951925     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Granulocyte colony-stimulating factor (G-CSF) stimulates the production of neutrophils and modulates the function and 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 therapy in patients with septic shock. AIM: To evaluate the introduction of G-CSF as an adjunct to our standard treatment for community-acquired septic shock. METHODS: We performed a prospective data collection and analysis to determine whether the addition of G-CSF to our standard treatment for community-acquired septic shock was associated with improved hospital outcome, compared with an historical cohort of similar patients. We included all patients admitted to the Intensive Care Unit (ICU) with community-acquired septic shock between December 1998 and March 2000. Patients received 300 microg G-CSF intravenously daily for 10 days in addition to our standard treatment for community-acquired septic shock. G-CSF was discontinued early if the patient was discharged from ICU before 10 days or if the absolute neutrophil count exceeded 75 x 10(6)/mL. RESULTS: A total of 36 patients with community-acquired septic shock, an average Apache 2 score of 26.7, and a predicted mortality of 0.79, were treated with G-CSF from December 1998 to March 2000. Hospital mortality was 31% compared with an historical cohort of 11 similar patients with a hospital mortality of 73% (P = 0.018). In the subgroup of patients with melioidosis septic shock, the hospital survival improved from 5% to 100% (P < 0.0001). No significant adverse events occurred as a result of the administration of G-CSF. CONCLUSION: G-CSF is a safe adjunctive therapy in community-acquired septic shock and may be associated with improved outcome. The use of G-CSF in septic shock should undergo further investigation to define subgroups of patients who may benefit from G-CSF. The use of G-CSF in patients with septic shock due to Burkholderia pseudomallei is recommended.
Authors:
D P Stephens; D A Fisher; B J Currie
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Internal medicine journal     Volume:  32     ISSN:  1444-0903     ISO Abbreviation:  Intern Med J     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-04-15     Completed Date:  2002-10-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  143-8     Citation Subset:  IM    
Affiliation:
Royal Darwin Hospital, Tiwi, Northern Territory, Australia. dianne.stephens@nt.gov.au
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / administration & dosage
Australia
Chemotherapy, Adjuvant
Cohort Studies
Community-Acquired Infections / drug therapy,  mortality
Critical Care / methods*
Drug Therapy, Combination
Female
Granulocyte Colony-Stimulating Factor / administration & dosage*
Hospital Mortality / trends
Humans
Intensive Care Units / standards*
Male
Medical Audit*
Middle Aged
Prospective Studies
Reference Values
Severity of Illness Index
Shock, Septic / diagnosis,  drug therapy*,  mortality
Survival Rate
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 143011-72-7/Granulocyte Colony-Stimulating Factor

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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