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Clinical Investigations in Critical Care |

Alveolar Granulocyte Colony-Stimulating Factor and α-Chemokines in Relation to Serum Levels, Pulmonary Neutrophilia, and Severity of Lung Injury in ARDS*

Franz J. Wiedermann; Andreas J. Mayr; Nicole C. Kaneider; Dietmar Fuchs; Norbert J. Mutz; Wolfgang Schobersberger
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*From the Departments of Anesthesiology and Critical Care Medicine (Drs. Wiedermann, Mayr, Mutz, and Schobersberger), Internal Medicine (Dr. Kaneider), and Chemistry and Biochemistry (Dr. Fuchs), Leopold-Franzens-University of Innsbruck, Innsbruck, Austria.

Correspondence to: Franz J. Wiedermann, MD, Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria; e-mail: franz.wiedermann@uibk.ac.at



Chest. 2004;125(1):212-219. doi:10.1378/chest.125.1.212
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Objectives: To determine granulocyte colony-stimulating factor (G-CSF), epithelial neutrophil-activating peptide (ENA)-78, and interleukin (IL)-8 in BAL fluid (BALF), epithelial lining fluid (ELF), and serum for establishing the concentration gradient of G-CSF, ENA-78, and IL-8 between the blood and the alveolar space in ARDS and acute lung injury (ALI); and to evaluate the relationship of G-CSF, IL-8, and ENA-78 to pulmonary neutrophilia and severity of lung injury.

Design: Prospective study.

Setting: An adult trauma/surgical ICU.

Patients: Nineteen patients with ARDS and 10 patients with ALI.

Interventions: None.

Measurements and main results: BAL and blood sampling simultaneously within 12 h and 24 h after onset of ARDS/ALI; G-CSF was detected in BALF in 18 of 19 patients with ARDS, in 7 of 10 patients with ALI, and in all serum samples. G-CSF in BALF and serum was significantly higher in ARDS than in ALI. ENA-78 was detected in BALF in 14 of 19 patients with ARDS, in 8 of 10 patients with ALI, and in serum of all patients. Levels in BALF and serum were not different between ARDS and ALI. IL-8 was detected in all patients; concentrations in BALF in ARDS were significantly higher than in ALI. Concentrations of G-CSF, ENA-78, and IL-8 in ELF were significantly higher than in serum. G-CSF in BALF and serum and IL-8 in BALF correlated positively with pulmonary neutrophilia. G-CSF in serum and IL-8 in BALF correlated negatively with Pao2/fraction of inspired oxygen (Fio2) ratio. However, ENA-78 did not show a correlation with neutrophil count or with Pao2/Fio2 ratio.

Conclusions: G-CSF may be pathophysiologically important for accumulation and activation of neutrophils in ARDS. Local G-CSF production is the likely driving force for neutrophils rather than elevation of circulating levels. In comparison to ENA-78, IL-8 seems to be the predominant neutrophil chemoattractant in the early phase of ARDS.

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