@article {Pinder918, author = {Emma M Pinder and Anthony J Rostron and Thomas P Hellyer and Marie-Helene Ruchaud-Sparagano and Jonathan Scott and James G Macfarlane and Sarah Wiscombe and John D Widdrington and Alistair I Roy and Vanessa C Linnett and Simon V Baudouin and Stephen E Wright and Thomas Chadwick and Tony Fouweather and Jatinder K Juss and Edwin R Chilvers and Susan A Bowett and Jennie Parker and Daniel F McAuley and Andrew Conway Morris and A John Simpson}, title = {Randomised controlled trial of GM-CSF in critically ill patients with impaired neutrophil phagocytosis}, volume = {73}, number = {10}, pages = {918--925}, year = {2018}, doi = {10.1136/thoraxjnl-2017-211323}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Critically ill patients with impaired neutrophil phagocytosis have significantly increased risk of nosocomial infection. Granulocyte-macrophage colony-stimulating factor (GM-CSF) improves phagocytosis by neutrophils ex vivo. This study tested the hypothesis that GM-CSF improves neutrophil phagocytosis in critically ill patients in whom phagocytosis is known to be impaired.Methods This was a multicentre, phase IIa randomised, placebo-controlled clinical trial. Using a personalised medicine approach, only critically ill patients with impaired neutrophil phagocytosis were included. Patients were randomised 1:1 to subcutaneous GM-CSF (3 μg/kg/day) or placebo, once daily for 4 days. The primary outcome measure was neutrophil phagocytosis 2 days after initiation of GM-CSF. Secondary outcomes included neutrophil phagocytosis over time, neutrophil functions other than phagocytosis, monocyte HLA-DR expression and safety.Results Thirty-eight patients were recruited from five intensive care units (17 randomised to GM-CSF). Mean neutrophil phagocytosis at day 2 was 57.2\% (SD 13.2\%) in the GM-CSF group and 49.8\% (13.4\%) in the placebo group, p=0.73. The proportion of patients with neutrophil phagocytosis>=50\% at day 2, and monocyte HLA-DR, appeared significantly higher in the GM-CSF group. Neutrophil functions other than phagocytosis did not appear significantly different between the groups. The most common adverse event associated with GM-CSF was fever.Conclusions GM-CSF did not improve mean neutrophil phagocytosis at day 2, but was safe and appeared to increase the proportion of patients with adequate phagocytosis. The study suggests proof of principle for a pharmacological effect on neutrophil function in a subset of critically ill patients.}, issn = {0040-6376}, URL = {https://thorax.bmj.com/content/73/10/918}, eprint = {https://thorax.bmj.com/content/73/10/918.full.pdf}, journal = {Thorax} }