Impact of colony-stimulating factor therapy on clinical outcome and frequency rate of nosocomial infections in intensive care unit neutropenic patients

Objectives: To determine whether the use of recombinant human granulocyte c olony-stimulating factor (G-CSF, filgrastim) reduces the mortality rate and the frequency rate of nosocomial infections in neutropenic patients requir ing intensive care unit (ICU) admission. Design: Retrospective consecutive case series analysis. Setting: Medical ICU of a teaching hospital. Patients: We compared two groups of patients, according to whether or not t hey received G-CSF. In the ICU, 28 leukopenic patients received filgrastim (5 mu g of body weight per day intravenously), in all these patients, G-CSF was continued until recovery from leukopenia, defined as a leukocyte count >1000/mm(3). A total of 33 ICU leukopenic patients did not receive G-CSF. End points included leukocyte count, bone marrow recovery, frequency of ICU nosocomial infections (pneumonia, urinary tract, and catheter-related infe ctions), and mortality rate. Measurements and Main Results:There were no differences in number of patien ts who recovered from leukopenia or in whom blood leukocyte count increased . Nosocomial infections occurred in the same percentage in both groups. The percentage of patients who died was identical in both groups. The percenta ge of patients with and without filgrastim therapy who recovered from leuko penia but died, was 86% and 78%, respectively. Conclusion: In the ICU, clinical outcome of neutropenic patients was not ch anged by G-CSF therapy. It is possible that G-CSF therapy may not be helpfu l in improving the ICU clinical outcome of neutropenic patients. Additional controlled studies designed to address this question are warranted.