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 bein...
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MDPI AG
2023-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/20/6541 |
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| author | Georgios Konstantis Georgia Tsaousi Chryssa Pourzitaki Elisavet Kitsikidou Dimitrios E. Magouliotis Sebastian Wiener Amos Cornelius Zeller Katharina Willuweit Hartmut H. Schmidt Jassin Rashidi-Alavijeh |
| author_facet | Georgios Konstantis Georgia Tsaousi Chryssa Pourzitaki Elisavet Kitsikidou Dimitrios E. Magouliotis Sebastian Wiener Amos Cornelius Zeller Katharina Willuweit Hartmut H. Schmidt Jassin Rashidi-Alavijeh |
| author_sort | Georgios Konstantis |
| collection | DOAJ |
| description | 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 I<sup>2</sup> 48%), leading to a decreased mortality (LogOR-0.97, 95% CI −1.57 to −0.37, and I<sup>2</sup> 37.6%) and improved Model for End-Stage Liver Disease (MELD) scores (SMD −0.87, 95% CI −1.62 to −0.13, and I<sup>2</sup> 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 I<sup>2</sup> 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 I<sup>2</sup> 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. |
| first_indexed | 2024-03-10T21:09:41Z |
| format | Article |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T21:09:41Z |
| publishDate | 2023-10-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-4326a291f1654481b443075e81fe06962023-11-19T16:52:33ZengMDPI AGJournal of Clinical Medicine2077-03832023-10-011220654110.3390/jcm12206541Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-AnalysisGeorgios Konstantis0Georgia Tsaousi1Chryssa Pourzitaki2Elisavet Kitsikidou3Dimitrios E. Magouliotis4Sebastian Wiener5Amos Cornelius Zeller6Katharina Willuweit7Hartmut H. Schmidt8Jassin Rashidi-Alavijeh9Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceDepartment of Anesthesiology and ICU, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceClinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, GreeceDepartment of Internal Medicine, Evangelical Hospital Dusseldorf, 40217 Dusseldorf, GermanyDepartment of Surgery, University of Thessaly, Biopolis, 41110 Larissa, GreeceDepartment of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, 40219 Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, 40219 Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, 40219 Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, 40219 Essen, GermanyDepartment of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, 40219 Essen, GermanyBackground: 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 I<sup>2</sup> 48%), leading to a decreased mortality (LogOR-0.97, 95% CI −1.57 to −0.37, and I<sup>2</sup> 37.6%) and improved Model for End-Stage Liver Disease (MELD) scores (SMD −0.87, 95% CI −1.62 to −0.13, and I<sup>2</sup> 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 I<sup>2</sup> 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 I<sup>2</sup> 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.https://www.mdpi.com/2077-0383/12/20/6541liver failurefailureacute on chronic liver (ACLF)acute-on-chronic liver failuregranulocyte colony-stimulating factor (G-CSF) |
| spellingShingle | Georgios Konstantis Georgia Tsaousi Chryssa Pourzitaki Elisavet Kitsikidou Dimitrios E. Magouliotis Sebastian Wiener Amos Cornelius Zeller Katharina Willuweit Hartmut H. Schmidt Jassin Rashidi-Alavijeh Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-Analysis Journal of Clinical Medicine liver failure failure acute on chronic liver (ACLF) acute-on-chronic liver failure granulocyte colony-stimulating factor (G-CSF) |
| title | Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-Analysis |
| title_full | Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-Analysis |
| title_fullStr | Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-Analysis |
| title_full_unstemmed | Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-Analysis |
| title_short | Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-Analysis |
| title_sort | efficacy of granulocyte colony stimulating factor in acute on chronic liver failure a systematic review and survival meta analysis |
| topic | liver failure failure acute on chronic liver (ACLF) acute-on-chronic liver failure granulocyte colony-stimulating factor (G-CSF) |
| url | https://www.mdpi.com/2077-0383/12/20/6541 |
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