Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure : A Systematic Review and Survival Meta-Analysis
BACKGROUND: Acute-on-chronic liver failure (ACLF) mostly occurs when there is an acute insult to the liver in patients with pre-existing liver disease, and it is characterized by a high mortality rate. Various therapeutic approaches have been used thus far, with orthotopic liver transplantation being the only definitive cure. Clinical trials and meta-analyses have investigated the use of granulocyte colony-stimulating factor (G-CSF) to mobilize bone marrow-derived stem cells. Some studies have suggested that G-CSF may have a significant role in the management and survival of patients with ACLF. However, the results are conflicting, and the efficacy of G-CSF still needs to be confirmed.
AIM: The aim was to assess the efficacy of G-CSF in patients with ACLF.
METHODS: Electronic databases were searched until May 2023 for randomized controlled trials investigating the use of G-CSF in adult patients with ACLF. Outcome measures were the effects of G-CSF on overall survival, changes in liver disease severity scores, complications of cirrhosis, other G-CSF-related adverse effects, and all-cause mortality. The study's protocol has been registered with Prospero (CRD42023420273).
RESULTS: Five double-blind randomized controlled trials involving a total of 421 participants met the inclusion criteria. The use of G-CSF demonstrated a significant effect on overall survival (HR 0.63, 95% CI 0.41 to 0.95, and I2 48%), leading to a decreased mortality (LogOR-0.97, 95% CI -1.57 to -0.37, and I2 37.6%) and improved Model for End-Stage Liver Disease (MELD) scores (SMD -0.87, 95% CI -1.62 to -0.13, and I2 87.3%). There was no correlation between the improvement of the Child-Pugh score and the use of G-CSF(SMD -2.47, 95% CI -5.78 to 0.83, and I2 98.1%). The incidence of complications of cirrhosis did not decrease significantly with G-CSF treatment (rate ratio 0.51, 95% CI 0.26 to 1.01, and I2 90%). A qualitative synthesis showed that the use of G-CSF is safe.
CONCLUSIONS: The administration of G-CSF has demonstrated a positive impact on overall survival, liver function, and the MELD score. The presence of heterogeneity in the included studies prohibits conclusive recommendations.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Journal of clinical medicine - 12(2023), 20 vom: 16. Okt. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Konstantis, Georgios [VerfasserIn] |
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| Links: |
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| Themen: |
Acute on chronic liver (ACLF) |
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| Anmerkungen: |
Date Revised 30.10.2023 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.3390/jcm12206541 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM363846964 |
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| 100 | 1 | |a Konstantis, Georgios |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure |b A Systematic Review and Survival Meta-Analysis |
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| 500 | |a Date Revised 30.10.2023 | ||
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| 520 | |a BACKGROUND: Acute-on-chronic liver failure (ACLF) mostly occurs when there is an acute insult to the liver in patients with pre-existing liver disease, and it is characterized by a high mortality rate. Various therapeutic approaches have been used thus far, with orthotopic liver transplantation being the only definitive cure. Clinical trials and meta-analyses have investigated the use of granulocyte colony-stimulating factor (G-CSF) to mobilize bone marrow-derived stem cells. Some studies have suggested that G-CSF may have a significant role in the management and survival of patients with ACLF. However, the results are conflicting, and the efficacy of G-CSF still needs to be confirmed | ||
| 520 | |a AIM: The aim was to assess the efficacy of G-CSF in patients with ACLF | ||
| 520 | |a METHODS: Electronic databases were searched until May 2023 for randomized controlled trials investigating the use of G-CSF in adult patients with ACLF. Outcome measures were the effects of G-CSF on overall survival, changes in liver disease severity scores, complications of cirrhosis, other G-CSF-related adverse effects, and all-cause mortality. The study's protocol has been registered with Prospero (CRD42023420273) | ||
| 520 | |a RESULTS: Five double-blind randomized controlled trials involving a total of 421 participants met the inclusion criteria. The use of G-CSF demonstrated a significant effect on overall survival (HR 0.63, 95% CI 0.41 to 0.95, and I2 48%), leading to a decreased mortality (LogOR-0.97, 95% CI -1.57 to -0.37, and I2 37.6%) and improved Model for End-Stage Liver Disease (MELD) scores (SMD -0.87, 95% CI -1.62 to -0.13, and I2 87.3%). There was no correlation between the improvement of the Child-Pugh score and the use of G-CSF(SMD -2.47, 95% CI -5.78 to 0.83, and I2 98.1%). The incidence of complications of cirrhosis did not decrease significantly with G-CSF treatment (rate ratio 0.51, 95% CI 0.26 to 1.01, and I2 90%). A qualitative synthesis showed that the use of G-CSF is safe | ||
| 520 | |a CONCLUSIONS: The administration of G-CSF has demonstrated a positive impact on overall survival, liver function, and the MELD score. The presence of heterogeneity in the included studies prohibits conclusive recommendations | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a acute on chronic liver (ACLF) | |
| 650 | 4 | |a acute-on-chronic liver failure | |
| 650 | 4 | |a failure | |
| 650 | 4 | |a granulocyte colony-stimulating factor (G-CSF) | |
| 650 | 4 | |a liver failure | |
| 700 | 1 | |a Tsaousi, Georgia |e verfasserin |4 aut | |
| 700 | 1 | |a Pourzitaki, Chryssa |e verfasserin |4 aut | |
| 700 | 1 | |a Kitsikidou, Elisavet |e verfasserin |4 aut | |
| 700 | 1 | |a Magouliotis, Dimitrios E |e verfasserin |4 aut | |
| 700 | 1 | |a Wiener, Sebastian |e verfasserin |4 aut | |
| 700 | 1 | |a Zeller, Amos Cornelius |e verfasserin |4 aut | |
| 700 | 1 | |a Willuweit, Katharina |e verfasserin |4 aut | |
| 700 | 1 | |a Schmidt, Hartmut H |e verfasserin |4 aut | |
| 700 | 1 | |a Rashidi-Alavijeh, Jassin |e verfasserin |4 aut | |
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