Difference in the responses after administration of granulocyte colony-stimulating factor in septic patients with relative neutropenia

Objective: The objective of this study was to classify the clinical respons es after administration of granulocyte colony-stimulating factor (G-CSF) in septic patients with relative neutropenia. Patients and Methods: We administered recombinant human G-CSF (2 mu g/kg) s ubcutaneously once a day for 5 days to 30 septic patients with white cell c ounts below 5,000 cells/mm(3). Absolute neutrophil count (ANC), neutrophil differentiation, and serum concentration of G-CSF were determined serially. Bone marrow also was analyzed before and after treatment. Results: Neutrophil responses to G-CSF varied from good (ANC > 10,000/mm(3) , group G, n = 20) to moderate (ANC < 10,000/mm(3), group M, n = 5) to poor (no increase in ANC, group P, n = 5). Before G-CSF administration, the thr ee groups showed no differences in ANC but did show significant differences in serum concentration of G-CSF. G-CSF concentration was 0.16 +/- 0.03 ng/ mL in group G, 7.0 +/- 3.0 ng/mL in group M, and 270 +/- 90 ng/mL in group P. Immature neutrophils accounted for 35.0 +/- 3.7% of peripheral leukocyte s in group P but only 5.1 +/- 0.6% in group G. Although bone marrow was dep ressed in all groups before C-CSF treatment, nucleated cell count increased significantly after rhG-CSF treatment in groups G and M. Survival rate aft er 4 weeks was 90% in group G and 100% in group M; no patient in group P su rvived. Conclusion: G-CSF administration was effective in septic patients with a lo w percentage of immature neutrophils and insufficient endogenous G-CSF, It had little effect on patients with a high percentage of immature neutrophil s whose C-CSF production was up-regulated and whose bone marrow,vas severel y depressed.