Purpose Surgical patients are at high risk for developing infectious
complications and postoperative delirium. Prolonged infections and delirium
result in worse outcome. Granulocyte-macrophage colony-stimulating factor (GM-
CSF) and influenza vaccination are known to increase HLA-DR on monocytes and
improve immune reactivity. This study aimed to investigate whether GM-CSF or
vaccination reverses monocyte deactivation. Secondary aims were whether it
decreases infection and delirium days after esophageal or pancreatic resection
over time. Methods In this prospective, randomized, placebo-controlled,
double-blind, double dummy trial setting on an interdisciplinary ICU of a
university hospital 61 patients with immunosuppression (monocytic HLA-DR
[mHLA-DR] <10,000 monoclonal antibodies [mAb] per cell) on the first day after
esophageal or pancreatic resection were treated with either GM-CSF (250
μg/m2/d), influenza vaccination (Mutagrip 0.5 ml/d) or placebo for a maximum
of 3 consecutive days if mHLA-DR remained below 10,000 mAb per cell. HLA-DR on
monocytes was measured daily until day 5 after surgery. Infections and
delirium were followed up for 9 days after surgery. Primary outcome was HLA-DR
on monocytes, and secondary outcomes were duration of infection and delirium.
Results mHLA-DR was significantly increased compared to placebo (p < 0.001)
and influenza vaccination (p < 0.001) on the second postoperative day.
Compared with placebo, GM-CSF-treated patients revealed shorter duration of
infection (p < 0.001); the duration of delirium was increased after
vaccination (p = 0.003). Conclusion Treatment with GM-CSF in patients with
postoperative immune suppression was safe and effective in restoring monocytic
immune competence. Furthermore, therapy with GM-CSF reduced duration of
infection in immune compromised patients. However, influenza vaccination
increased duration of delirium after major surgery
