Critical Care Vol 5 Suppl 1 21st International Symposium on Intensive Care and Emergency Medicine
Methods: Ten anaesthetised, and multi-catheterised pigs (20.6
1.3 kg) were investigated over a period of 8 h. Sepsis was induced
by fecal peritonitis. Animals were infused using 6% hydroxyethyl
starch 200/0.5 to maintain a CVP of 12 mmHg. In kidneys biopsies
TCC deposition was detected immunohistologically. Plasma levels
of TCC were measured in a double antibody EIA using the neoepi-
tope-specific MoAb aE11 as catching antibody. Albumin escape
rate (AER; tc 99m-labeled albumin), serum protein (S-Protein), and
hematocrit (Hct) were determined. After verifying normal data dis-
tribution skewnesss < 1.5) Student's t-test was performed by rank-
ordered stepwise testing. Data are mean SD.
Results: Septic animals showed marked renal deposition of TCC.
Other results, see Table.
Conclusion: Although plasma levels of TCC declined over study
period, in septic animals marked renal depositions of TCC indi-
cated complement activation. Since AER increased and serum
protein levels decreased, capillary loss of TCC into organ tissue
may explain our findings in part. We conclude that in septic shock
with substantial CLS plasma levels of TCC may not reflect degree
of complement activation.
1. Nuijens JH etal: Blood 1988, 72:1841-1848.
Sepsis Control Sepsis Control Sepsis Control
TCC(0/o) 104+40 118+37 22 + 29* 58 + 11* 16+31* 20 + 22*
S-Protein (g/1) 43 + 4 42 + 2 13 + 2*t 26 + 9* 9 + 1*t 22 + 4
AER (%/o) 39 + 16* 5+5 52 + 26* 3+10
Hct(%) 29+1 29+2 30+5 25 +3* 29 +3* 26+1
* P< 0.05 compared with baseline. t P< 0.05 compared with control group.
Peaks in G-CSF serum concentrations are accompanied by an increase in phagocytotic activity in most patients with
severe sepsis or septic shock
G Fischer*, E Barth*, H Wiedeck*, LL Moldawer+, EM Schneider*, M Georgieff*, M Weiss*
*Department of Anesthesiology, University of Ulm, Germany; *Department of Surgery, University of Florida, Gainesville, FL, USA
Objectives: To investigate the relationship between endogenous Results: A G-CSF peak was defined as an increase of at least
serum concentrations of granulocyte colony stimulating factor (G- 30% from one day to the other, followed by a decrease of at least
CSF) and phagocytotic activity of granulocytes during septic shock 15% on the next day. The following results are expressed as
in postoperative/post-traumatic patients. median (min max) values. In seven episodes there was a parallel
course of the G-CSF peak and phagocytosis with an increase in
Methods: Over a 6 month period 35 patients with proven infec- phagocytosis by 37% (6-50%). In 11 episodes, phagocytosis
tion and severe sepsis or septic shock for at least 3 days' dura- continuously increased and remained on a higher level after the
tion were monitored on a daily basis during their stay in the increase of 100/0 (1-164%) from day 1 up to day 2. In 10
intensive care unit (ICU) until discharge from the ICU or death. episodes, there was a decrease by 40% (1 7-76%) at the day of
In 19 out of these 35 patients one or more peaks in G-CSF the G-CSF peak, followed by an increase by 58% (6-322%) on
serum concentrations occurred. Eleven of these 19 patients sur- the next day. In 12 episodes, there was no increase (n = 4) or even
vived, eight patients died. A longitudinal analysis of G-CSF a decrease (n = 8) by 24% (3-46%) over all days.
serum concentrations, phagocytotic activity of granulocytes and
surface expression of monomeric Fc receptor type I (CD64, Conclusions: A peak in G-CSF serum concentration was followed
FcyRI) on granulocytes was performed by ELISA technique by a continuous increase in phagocytosis at the same day in 7, and
(R&D Systems, Minneapolis, MN, USA) and flow cytometry a delayed increase in 21 out of 40 episodes, but no increase or
(PhagotestT; Orpegen, Heidelberg, Germany) and CD64 (clone even an decrease in 12 out of 40 episodes. Thus, phagocytotic
22; Immunotech, Krefeld, Germany), respectively on a daily activity is increased when G-CSF peaks endogenously, in most
basis. patients with severe sepsis or septic shock.
Influence of GM-CSF supplementation on PaO2/FiO2 index in septic patients
P Myrianthefs, E Karabatsos, E Boutzouka, P Evagelopoulou, G Georgiadis, G Fildissis, G Baltopoulos
Athens University, School of Nursing, ICU, KAT Hospital, Athens, Greece
Introduction: Granulocyte-Macrophage Colony-Stimulating Factor
(rHuGM-CSF) is used in leucopenic febrile patients to enhance
leukocyte production. It can prime resting monocytes and augment
their inflammatory response . It strongly up-regulates HLA-DR
expression, LPS induced TNF-c monocyte secretion and down-
regulates anti-inflammatory cytokines release .