The effect of GM-CSF and predictors of treatment outcome in pediatric septic shock patients

Background Septic shock in pediatric patients frequently leads to high mortality rates, primarily attribute to sepsis-induced immunosuppression. Granulocyte-macrophage colony-stimulating factor (GM-CSF) has emerged as a potential therapy to mitigate this immunosuppression. However, the effect of GM-CSF in pediatric septic shock remains uncertain. This study aimed to investigate the effect of GM-CSF administration and identify the potential treatment outcome predictors in pediatric patients with septic shock. Methods The retrospective cohort study was structured to include pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) of Children’s Hospital of Fudan University in Shanghai, between January 1 ^st , 2019 and January 1 ^st , 2024, who were diagnosed with septic shock during hospitalization. Data were collected on the demographic characteristics of patients, treatments of GM-CSF and other combined therapies, laboratory findings, and clinical outcomes. Univariate and multivariate logistic regression were utilized to evaluate the effect of GM-CSF on 28-day mortality and identify its potential treatment outcome predictors. Results A total of 200 patients were included in the study: 66 in GM-CSF treatment group and 134 in no GM-CSF treatment group. The 28-day mortality of GM-CSF group showed higher risk compared with no GM-CSF group (59.1% vs. 35.1%, P =0.001). In the multivariate logistic regression analysis, the effect of GM-CSF showed decreased the risk of 28-day mortality (OR=0.472, 95% CI 0.153-1.457, P =0.192) after adjusting the confounding factors. Potential outcome predictors of GM-CSF treatment included hematopoietic stem cell transplantation (HSCT), lactic acid (LAC) levels, hospital-acquired septic shock (HASS), red blood cell (RBC) count, and platelet (PLT) count. Conclusions GM-CSF treatment showed clinical benefit in pediatric septic shock patients, especially with higher LAC, lower RBC, lower PLT. The potential treatment outcome predictors can be monitored during the treatment of pediatric septic shock.