Reversal of immunoparalysis by recombinant human granulocyte-macrophage colony-stimulating factor in patients with severe sepsis.
Standard
Reversal of immunoparalysis by recombinant human granulocyte-macrophage colony-stimulating factor in patients with severe sepsis. / Nierhaus, Axel; Montag, Barbara; Timmler, Nicole; Frings, Daniel P; Gutensohn, Kai; Jung, Roman; Schneider, Claus G; Pothmann, Werner; Brassel, Anne K; Jochen, Schulte Am Esch.
in: INTENS CARE MED, Jahrgang 29, Nr. 4, 4, 2003, S. 646-651.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Reversal of immunoparalysis by recombinant human granulocyte-macrophage colony-stimulating factor in patients with severe sepsis.
AU - Nierhaus, Axel
AU - Montag, Barbara
AU - Timmler, Nicole
AU - Frings, Daniel P
AU - Gutensohn, Kai
AU - Jung, Roman
AU - Schneider, Claus G
AU - Pothmann, Werner
AU - Brassel, Anne K
AU - Jochen, Schulte Am Esch
PY - 2003
Y1 - 2003
N2 - OBJECTIVE: To evaluate the effect of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on immunoparalysis as defined by a sustained decrease of HLA-DR expression on monocytes in patients with severe sepsis. DESIGN: Prospective, non-randomised observational study. SETTING: Two anaesthesiological intensive care units of a university hospital. INTERVENTION: Administration of a daily dose of 5 micro g/kg rhGM-CSF over a period of 3 days. PATIENTS: Nine consecutive patients with severe sepsis and a documented HLA-DR expression on peripheral monocytes of less than 150 mean fluorescence intensity (MFI) over a period of at least 48 h prior to intervention. MEASUREMENTS AND RESULTS: Mean MFI was 69.4+/-13.2 24 h before and 56.7+/-8.2 on the day of the administration of 5 micro g/kg rhGM-CSF. Within 24 h a significant increase of HLA-DR expression to a mean of 327.7+/-78.8 MFI was observed in all patients. This increase was maintained on days 2-10. It was accompanied by a significant rise in white blood count. The ex vivo TNF-alpha production in whole blood after lipopolysaccharide (LPS)-stimulation increased significantly from a mean of 82+/-29.2 pg/ml to 793+/-546.8 pg/ml. Apart from febrile reactions in two patients, no side effects were recorded. No increases of pro-inflammatory markers (IL-6, C-reactive protein, LPS-binding protein, procalcitonin) were observed. SOFA values before and after rhGM-CSF did not differ significantly. The mortality rate was 33%. CONCLUSION: This preliminary study demonstrates that rhGM-CSF upregulates HLA-DR expression on monocytes in septic patients with multi-organ dysfunction. Moreover, with the concomitant increase of the ex vivo whole blood TNF-alpha response, this upregulation of a monocytic activation marker is paralleled by a functional recovery.
AB - OBJECTIVE: To evaluate the effect of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on immunoparalysis as defined by a sustained decrease of HLA-DR expression on monocytes in patients with severe sepsis. DESIGN: Prospective, non-randomised observational study. SETTING: Two anaesthesiological intensive care units of a university hospital. INTERVENTION: Administration of a daily dose of 5 micro g/kg rhGM-CSF over a period of 3 days. PATIENTS: Nine consecutive patients with severe sepsis and a documented HLA-DR expression on peripheral monocytes of less than 150 mean fluorescence intensity (MFI) over a period of at least 48 h prior to intervention. MEASUREMENTS AND RESULTS: Mean MFI was 69.4+/-13.2 24 h before and 56.7+/-8.2 on the day of the administration of 5 micro g/kg rhGM-CSF. Within 24 h a significant increase of HLA-DR expression to a mean of 327.7+/-78.8 MFI was observed in all patients. This increase was maintained on days 2-10. It was accompanied by a significant rise in white blood count. The ex vivo TNF-alpha production in whole blood after lipopolysaccharide (LPS)-stimulation increased significantly from a mean of 82+/-29.2 pg/ml to 793+/-546.8 pg/ml. Apart from febrile reactions in two patients, no side effects were recorded. No increases of pro-inflammatory markers (IL-6, C-reactive protein, LPS-binding protein, procalcitonin) were observed. SOFA values before and after rhGM-CSF did not differ significantly. The mortality rate was 33%. CONCLUSION: This preliminary study demonstrates that rhGM-CSF upregulates HLA-DR expression on monocytes in septic patients with multi-organ dysfunction. Moreover, with the concomitant increase of the ex vivo whole blood TNF-alpha response, this upregulation of a monocytic activation marker is paralleled by a functional recovery.
M3 - SCORING: Zeitschriftenaufsatz
VL - 29
SP - 646
EP - 651
JO - INTENS CARE MED
JF - INTENS CARE MED
SN - 0342-4642
IS - 4
M1 - 4
ER -