Plasma granulocyte colony-stimulating factor levels correlate with clinical outcomes in patients with acute lung injury.

Pubmed ID: 19242319

Pubmed Central ID: PMC2827851

Journal: Critical care medicine

Publication Date: April 1, 2009

Affiliation: Division of Pulmonary and Critical Care Medicine, Fletcher Allen Health Care, University of Vermont, VT, USA. benjamin.suratt@uvm.edu

MeSH Terms: Humans, Male, Female, Middle Aged, Prognosis, Retrospective Studies, Acute Lung Injury, Granulocyte Colony-Stimulating Factor, Respiratory Distress Syndrome

Grants: K08 HL0049, KL2RR024130, L30 HL074998, N01HR46064, R01 HL084200, R01 HL084200-04, KL2 RR024130

Authors: Parsons PE, Eisner MD, Suratt BT, Calfee CS, Allard JB, Whittaker LA, Engelken DT, Petty JM, Trimarchi T, Gauthier L

Cite As: Suratt BT, Eisner MD, Calfee CS, Allard JB, Whittaker LA, Engelken DT, Petty JM, Trimarchi T, Gauthier L, Parsons PE, NHLBI Acute Respiratory Distress Syndrome Network. Plasma granulocyte colony-stimulating factor levels correlate with clinical outcomes in patients with acute lung injury. Crit Care Med 2009 Apr;37(4):1322-8.

Studies:

Acute Respiratory Distress Network (ARDSNet) Studies 01 and 03 Lower versus higher tidal volume, ketoconazole treatment and lisofylline treatment (ARMA/KARMA/LARMA)

Abstract

OBJECTIVES: To evaluate the association between plasma granulocyte colony-stimulating factor (G-CSF) levels and clinical outcomes including mortality in patients with acute lung injury (ALI), and to determine whether lower tidal volume ventilation was associated with a more rapid decrease in plasma G-CSF over time in patients with ALI. DESIGN: Retrospective measurement of G-CSF levels in plasma samples that were collected prospectively as part of a large multicenter clinical trial. SETTING: Intensive care units in ten university centers. PATIENTS: The study included 645 patients enrolled in the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Network trial of lower tidal volumes compared with traditional tidal volumes for ALI. MEASUREMENTS AND MAIN RESULTS: Baseline plasma levels of G-CSF were associated with an increased risk of death and a decrease in ventilator-free days and organ failure-free days in multivariate analyses controlling for ventilation strategy, age, and sex (Odds ratio death 1.2/log10 increment G-CSF, 95% confidence interval 1.01 to 1.4). Stratification of G-CSF levels into quartiles revealed a strong association between the highest levels of G-CSF and an increased risk of death and decreased ventilator-free days and organ failure-free days in multivariate analyses controlling for ventilation strategy, Acute Physiology and Chronic Health Evaluation III score, Pao2/Fio2 ratio, creatinine, and platelet count (p < 0.05). Subgroup multivariate analysis of patients with sepsis as their risk factor for ALI revealed a U-shaped association between mortality and G-CSF levels such that risk increased linearly from the second through fourth (highest) quartiles, yet also increased in the first (lowest) quartile. G-CSF levels decreased over time in both tidal volume groups, and there was no statistical difference in the extent of decrease between ventilator strategies. CONCLUSIONS: In patients with ALI, plasma G-CSF levels are associated with morbidity and mortality, but these levels are not influenced by tidal volume strategy. In patients with sepsis-related ALI, a bimodal association between baseline plasma G-CSF levels and subsequent morbidity and mortality from this disease was found.