Effects of Granulocyte Colony-Stimulating Factor on Patients with Liver Failure: a Meta-Analysis

Qiao Yang, Ying Yang, Yu Shi, Fangfang Lv, Jiliang He, Zhi Chen, Qiao Yang, Ying Yang, Yu Shi, Fangfang Lv, Jiliang He, Zhi Chen

Abstract

Background and aims: It remains controversial whether granulocyte colony-stimulating factor (G-CSF) prolongs survival in liver failure (LF) patients. This meta-analysis was performed to evaluate the effect of G-CSF on patients with LF.

Methods: PubMed, EMBASE, and Web of Science databases were searched to identify English language randomized controlled trials comparing G-CSF with control therapy published before14 February 2015. A meta-analysis was performed to examine changes in liver function and patient survival. The association was tested using odds ratio (OR) or risk ratio (RR) with 95% confidence intervals (CI).

Results: Five randomized controlled trials were eligible for the meta-analysis. Significant amelioration of prothrombin time and total bilirubin in LF patients was attributed to G-CSF therapy (OR, -0.064; 95% CI,-0.481 to 0.353; p< 0.001; and OR, -0.803; 95% CI, -1.177 to -0.430; p = 0.000, respectively). Treatment with G-CSF resulted in improved Model for End-Stage Liver Disease and Child-Turcotte-Pugh scores (OR, -1.741; 95% CI, -2.234 to -1.250; p = 0.000; and OR, -0.830, 95% CI, -1.194 to -0.465; p = 0.000, respectively). A lower incidence of sepsis was found in patients treated with G-CSF (RR, 0.367; 95% CI, 0.158 to 0.854; p = 0.020). G-CSF therapy significantly increased survival rate in LF patients (RR, 2.25; 95% CI, 1.517 to 3.338; p = 0.000).

Conclusions: The results of this meta-analysis indicate that G-CSF treatment in patients with LF significantly improved liver function, reduced the incidence of sepsis, and prolonged short-term survival.

Keywords: Granulocyte colony-stimulating factor; Liver failure; Liver regeneration; Stem cells.

Conflict of interest statement

None

Figures

Fig. 1.. Flow diagram of the selection…
Fig. 1.. Flow diagram of the selection process.
Five studies assessed G-CSF use and outcomes in LF. Abbreviations: G-CSF, granulocyte colony-stimulating factor; LF, liver failure.
Fig. 2.. Meta-analysis of the neutrophils and…
Fig. 2.. Meta-analysis of the neutrophils and CD34+ cell counts in peripheral blood between G-CSF and control therapy.
(A) Neutrophil counts in peripheral blood. (B) CD34+ cell counts in peripheral blood. Abbreviation: G-CSF, granulocyte colony-stimulating factor.
Fig. 3.. Meta-analysis of the levels of…
Fig. 3.. Meta-analysis of the levels of prothrombin time and total bilirubin between G-CSF and control therapy.
(A) The levels of prothrombin time. (B) The level of total bilirubin. Abbreviation: G-CSF, granulocyte colony-stimulating factor.
Fig. 4.. Meta-analysis of MELD and CTP…
Fig. 4.. Meta-analysis of MELD and CTP scores between G-CSF and control therapy.
Abbreviations: CTP, Child-Turcotte-Pugh; MELD, Model for End-Stage Liver Disease; G-CSF, granulocyte colony-stimulating factor.
Fig. 5.. Meta-analysis of the occurrence of…
Fig. 5.. Meta-analysis of the occurrence of sepsis between G-CSF and control therapy.
Fig. 6.. Meta-analysis of the association between…
Fig. 6.. Meta-analysis of the association between G-CSF use and liver failure mortality.

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