A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand.
BACKGROUND: Melioidosis is a tropical infectious disease associated with significant mortality. Most deaths occur early and are caused by fulminant sepsis. METHODS: In this randomized, placebo-controlled trial, we assessed the efficacy of lenograstim (granulocyte colony-stimulating factor [G-CSF],...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
2007
|
| _version_ | 1826262043698659328 |
|---|---|
| author | Cheng, A Limmathurotsakul, D Chierakul, W Getchalarat, N Wuthiekanun, V Stephens, D Day, N White, N Chaowagul, W Currie, B Peacock, S |
| author_facet | Cheng, A Limmathurotsakul, D Chierakul, W Getchalarat, N Wuthiekanun, V Stephens, D Day, N White, N Chaowagul, W Currie, B Peacock, S |
| author_sort | Cheng, A |
| collection | OXFORD |
| description | BACKGROUND: Melioidosis is a tropical infectious disease associated with significant mortality. Most deaths occur early and are caused by fulminant sepsis. METHODS: In this randomized, placebo-controlled trial, we assessed the efficacy of lenograstim (granulocyte colony-stimulating factor [G-CSF], 263 mu g per day administered intravenously) in ceftazidime-treated patients with severe sepsis caused by suspected melioidosis in Thailand. RESULTS: Over a 27-month period, 60 patients were enrolled to receive either G-CSF (30 patients, 18 of whom had culture-confirmed melioidosis) or placebo (30 patients, 23 of whom had culture-confirmed melioidosis). Mortality rates were similar in both groups (G-CSF group, 70%; placebo group, 87%; risk ratio, 0.81; 95% confidence interval, 0.61-1.06; P=.2), including among patients with confirmed melioidosis (83% vs. 96%; P=.3). The duration of survival was longer for patients who received G-CSF than for patients who received placebo (33 h vs. 18.6 h; hazard ratio, 0.56; 95% confidence interval, 0.31-1.00; P=.05). CONCLUSIONS: Receipt of G-CSF is associated with a longer duration of survival but is not associated with a mortality benefit in patients with severe sepsis who are suspected of having melioidosis in Thailand. We hypothesize that G-CSF may "buy time" for severely septic patients, but survival is more likely to be improved by management of associated metabolic abnormalities and organ dysfunction associated with severe sepsis. |
| first_indexed | 2024-03-06T19:30:07Z |
| format | Journal article |
| id | oxford-uuid:1d2afb09-2bb1-4628-b067-13bdae19c9a0 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T19:30:07Z |
| publishDate | 2007 |
| record_format | dspace |
| spelling | oxford-uuid:1d2afb09-2bb1-4628-b067-13bdae19c9a02022-03-26T11:09:27ZA randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:1d2afb09-2bb1-4628-b067-13bdae19c9a0EnglishSymplectic Elements at Oxford2007Cheng, ALimmathurotsakul, DChierakul, WGetchalarat, NWuthiekanun, VStephens, DDay, NWhite, NChaowagul, WCurrie, BPeacock, S BACKGROUND: Melioidosis is a tropical infectious disease associated with significant mortality. Most deaths occur early and are caused by fulminant sepsis. METHODS: In this randomized, placebo-controlled trial, we assessed the efficacy of lenograstim (granulocyte colony-stimulating factor [G-CSF], 263 mu g per day administered intravenously) in ceftazidime-treated patients with severe sepsis caused by suspected melioidosis in Thailand. RESULTS: Over a 27-month period, 60 patients were enrolled to receive either G-CSF (30 patients, 18 of whom had culture-confirmed melioidosis) or placebo (30 patients, 23 of whom had culture-confirmed melioidosis). Mortality rates were similar in both groups (G-CSF group, 70%; placebo group, 87%; risk ratio, 0.81; 95% confidence interval, 0.61-1.06; P=.2), including among patients with confirmed melioidosis (83% vs. 96%; P=.3). The duration of survival was longer for patients who received G-CSF than for patients who received placebo (33 h vs. 18.6 h; hazard ratio, 0.56; 95% confidence interval, 0.31-1.00; P=.05). CONCLUSIONS: Receipt of G-CSF is associated with a longer duration of survival but is not associated with a mortality benefit in patients with severe sepsis who are suspected of having melioidosis in Thailand. We hypothesize that G-CSF may "buy time" for severely septic patients, but survival is more likely to be improved by management of associated metabolic abnormalities and organ dysfunction associated with severe sepsis. |
| spellingShingle | Cheng, A Limmathurotsakul, D Chierakul, W Getchalarat, N Wuthiekanun, V Stephens, D Day, N White, N Chaowagul, W Currie, B Peacock, S A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand. |
| title | A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand. |
| title_full | A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand. |
| title_fullStr | A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand. |
| title_full_unstemmed | A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand. |
| title_short | A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand. |
| title_sort | randomized controlled trial of granulocyte colony stimulating factor for the treatment of severe sepsis due to melioidosis in thailand |
| work_keys_str_mv | AT chenga arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT limmathurotsakuld arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT chierakulw arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT getchalaratn arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT wuthiekanunv arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT stephensd arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT dayn arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT whiten arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT chaowagulw arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT currieb arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT peacocks arandomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT chenga randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT limmathurotsakuld randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT chierakulw randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT getchalaratn randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT wuthiekanunv randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT stephensd randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT dayn randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT whiten randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT chaowagulw randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT currieb randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand AT peacocks randomizedcontrolledtrialofgranulocytecolonystimulatingfactorforthetreatmentofseveresepsisduetomelioidosisinthailand |