Plasma granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor levels in critical illness including sepsis and septic shock: Relation to disease severity, multiple organ dysfunction, and mortality

Objective: To define the circulating levels of granulocyte colony-stimulati ng factor (G-CSF) and granulocyte-macraphage colony-stimulating factor (GM- CSF) during critical illness and to determine their relationship to the sev erity of illness as measured by the Acute Physiology and Chronic Health Eva luation (APACHE) II score, the development of multiple organ dysfunction, o r mortality. Design: Prospective cohort study. Setting: University hospital intensive care unit. Patients: A total of 82 critically ill adult patients in four clinically de fined groups, namely septic shock (n = 29), sepsis without shock (n = 17), shock without sepsis (n = 22), and nonseptic, nonshock controls (n = 14). Interventions: None. Measurements and Main Results: During day 1 of septic shock peak plasma lev els of G-CSF, interleukin (IL)-6, and leukemia inhibitory factor (UF), but not GM-CSF, were greater than in sepsis or shock alone (p < .001), and were correlated among themselves (r(s) = 0.44-0.77; p < .02) and with the APACH E II score (r(s) = 0.25-0.40; p = .03 to .18). G-GSF, IL-6, and UF, and sep sis, shock, septic shock, and APACHE II scores were strongly associated wit h organ dysfunction or 5-day mortality by univariate analysis. However, mul tiple logistic regression analysis showed that only septic shock remained s ignificantly associated with organ dysfunction and only APACHE II scores an d shock with 5-day mortality. Similarly, peak G-CSF, IL-6, and UF were poor ly predictive of 30-day mortality. Conclusions: Plasma levels of G-GSF, IL-6, and LIF are greatly elevated in critical illness, including septic shock, and are correlated with one anoth er and with the severity of illness. However, they are not independently pr edictive of mortality, or the development of multiple organ dysfunction. GM -CSF was rarely elevated, suggesting different roles for G-GSF and GM-CSF i n human septic shock.