Efficacy of Granulocyte Colony Stimulating Factor in Severe Alcoholic Hepatitis: A Systematic Review and Meta-Analysis

Baig, Muhammad A.; Walayat, Saqib; Dhillon, Sonu; Puli, Srinivas R.

doi:10.7759/cureus.10474

Cited by 4 publications

(6 citation statements)

References 31 publications

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“…No significant differences in mortality secondary to complications, including multi-organ failure, gastrointestinal bleeding and sepsis were observed. Recently two meta-analyses [31,32] have clarified the effect of G-CSF on alcoholic hepatitis. Baig et al [31] proved the efficacy in improving 90-day survival and liver severity indices (Child-Turcotte-Pugh, MELD, and Maddrey discriminant function) after 28 days of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Recently two meta-analyses [31,32] have clarified the effect of G-CSF on alcoholic hepatitis. Baig et al [31] proved the efficacy in improving 90-day survival and liver severity indices (Child-Turcotte-Pugh, MELD, and Maddrey discriminant function) after 28 days of treatment. Marot et al [32] showed opposite results in Asian studies and studies, both for mortality and rate of infection.…”

Section: Discussionmentioning

confidence: 99%

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The effects of granulocyte-colony stimulating factor on chronic liver disease: a meta-analysis

Shi

Zhang

Wang

et al. 2022

J Infect Dev Ctries

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Introduction: The clinical application of granulocyte-colony stimulating factor on chronic liver disease is still controversial. The study aimed to evaluate the effects of granulocyte-colony stimulating factor on chronic liver disease. Methodology: A systematic literature search was performed in PubMed, Embase, Cochrane Library and Chinese Biomedical Literature database. Randomized-controlled trials assessing the efficacy of granulocyte-colony stimulating factor were selected. Results: Granulocyte-colony stimulating factor was associated with an increasing long-term survival (RR 1.54; 95% CI 1.22 to 1.94; p = 0.0003; heterogeneity: Q = 0.26, I2 = 25%) and an increasing short-term survival (RR 1.44; 95% CI 1.16 to 1.78; p = 0.0009; heterogeneity: Q < 0.00001, I2 = 80%). Granulocyte-colony stimulating factor failed to lower mortality secondary to multiple organ failure (RR 0.65; 95% CI 0.34 to 1.21; p = 0.17; heterogeneity: Q = 0.45; I2 = 0%), gastrointestinal bleeding mortality (RR 0.97; 95% CI 0.61 to 1.56; p = 0.91; heterogeneity: Q = 0.35; I2 = 11%) and sepsis mortality (RR 0.27; 95% CI 0.06 to 1.12; p = 0.07; heterogeneity: Q < 0.00001; I2 = 90%). It significantly lowered the Child-Turcotte-Pugh (MD=−0.97, 95% CI −1.48 to −0.45; p = 0.0003; heterogeneity: Q = 0.25; I2 = 28%). No serious adverse events were observed. Conclusions: Granulocyte-colony stimulating factor resulted in significantly improved 12-month survival and reduced Child-Turcotte-Pugh score with relative safety. Establishment of guidelines and protocols in future clinical trials will promote granulocyte-colony stimulating factor as an effective and safe therapy for chronic liver disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effects of granulocyte-colony stimulating factor on chronic liver disease: a meta-analysis

Shi

Zhang

Wang

et al. 2022

J Infect Dev Ctries

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“…It found a significantly improved survival at 90-days [56]. Two systematic reviews also found a significantly improved survival at 90 days in sAH patients treated with G-CSF compared to placebo or PTX [54,57]. Four ongoing trials are currently investigating the role of G-CSF in sAH patients.…”

Section: Boosting Liver Regenerationmentioning

confidence: 99%

Treatment of severe alcoholic hepatitis: A systematic review

Melkebeke

Korf

Tsochatzis

et al. 2021

Current Opinion in Pharmacology

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“…Subsequently, meta-analyses have examined the efficacy of G-CSF in AH with 5 studies in Asia showing a 90-day survival benefit and 2 studies in Europe showing no survival benefit but rather a trend to increased mortality. It has been proposed that study design variability accounted for mixed results (227,228). The combination of G-CSF and prednisolone has also yielded mixed results with a recent US trial showing equivalent 90-day survival to prednisolone (0.73 [95% CI 0.44-0.89] vs 0.83 [95% CI 0.57-0.94]; P .…”

Section: G-csfmentioning

confidence: 99%

ACG Clinical Guideline: Alcohol-Associated Liver Disease

Jophlin,

Singal,

Bataller

et al. 2023

Am J Gastroenterol

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Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and frequent indication for liver transplantation worldwide. With harmful alcohol use as the primary risk factor, increasing alcohol use over the past decade has resulted in rapid growth of the ALD-related healthcare burden. The spectrum of ALD ranges from early asymptomatic liver injury to advanced disease with decompensation and portal hypertension. Compared with those with other etiologies of liver disease, patients with ALD progress faster and more often present at an advanced stage. A unique phenotype of advanced disease is alcohol-associated hepatitis (AH) presenting with rapid onset or worsening of jaundice, and acute on chronic liver failure in severe forms conveying a 1-month mortality risk of 20%–50%. The model for end stage disease score is the most accurate score to stratify AH severity (>20 defined as severe disease). Corticosteroids are currently the only available therapeutic with proven efficacy for patients with severe AH, providing survival benefit at 1 month in 50%–60% of patients. Abstinence of alcohol use, a crucial determinant of long-term outcomes, is challenging to achieve in ALD patients with concurrent alcohol use disorder (AUD). As patients with ALD are rarely treated for AUD, strategies are needed to overcome barriers to AUD treatment in patients with ALD and to promote a multidisciplinary integrated care model with hepatology, addiction medicine providers, and social workers to comprehensively manage the dual pathologies of liver disease and of AUD. Liver transplantation, a definitive treatment option in patients with advanced cirrhosis, should be considered in selected patients with AH, who are unresponsive to medical therapy and have a low risk of relapse to posttransplant alcohol use. Level of evidence and strength of recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. This guideline was developed under the American College of Gastroenterology Practice Parameters Committee.

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Efficacy of Granulocyte Colony Stimulating Factor in Severe Alcoholic Hepatitis: A Systematic Review and Meta-Analysis

Abstract: Baig et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 4 publications

References 31 publications

The effects of granulocyte-colony stimulating factor on chronic liver disease: a meta-analysis

The effects of granulocyte-colony stimulating factor on chronic liver disease: a meta-analysis

Treatment of severe alcoholic hepatitis: A systematic review

ACG Clinical Guideline: Alcohol-Associated Liver Disease

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