Granulocyte colony-stimulating factor improves survival of patients with decompensated cirrhosis: a randomized-controlled trial

Prajapati, Ritesh; Arora, Anil; Sharma, Praveen; Bansal, Naresh; Singla, Vikas; Kumar, Ashish

doi:10.1097/meg.0000000000000801

Cited by 35 publications

(44 citation statements)

References 29 publications

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“…Prajapati et al 56 conducted the largest randomized controlled study of GCSF therapy, using 253 decompensated cirrhosis patients. The authors showed that the cumulative survival was significantly higher in GCSF-treated patients compared to controls (79 vs. 68%) and that significantly more patients in the GCSF group had an improvement in CTP scores at 180 days.…”

Section: Critical Appraisal Of Gcsf In Decompensated Cirrhosismentioning

confidence: 99%

“…Even though those authors stated that the inclusion of only decompensated cirrhosis as one of the strengths of their study, the table detailing patient characteristics shows the inclusion of acute-on-chronic liver failure (ACLF) patients also. ACLF patients have completely different disease mechanisms, progression, clinical outcome and possibly, distinct response to GCSF therapy in comparison to patients with decompensated cirrhosis, and hence the study by Prajapati and colleagues 56 does not fully realize the potential of GCSF use in decompensated cirrhosis. The authors do not discuss MELD progression in their study among GCSF-treated patients even though baseline values for the same are mentioned and the study is restricted to an intermediate follow up period.…”

Section: Critical Appraisal Of Gcsf In Decompensated Cirrhosismentioning

confidence: 99%

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Role of Granulocyte Colony-stimulating Factor Therapy in Cirrhosis, ‘Inside Any Deep Asking Is the Answering’

Philips¹,

Augustine²,

Ahamed³

et al. 2019

Journal of Clinical and Translational Hepatology

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Liver cirrhosis progresses through multiple clinical stages which culminate in either death or liver transplantation. Availability of organs, timely listing and prompt receipt of donor-livers pose difficulties in improving transplant-listed and transplant outcomes. In this regard, regenerative therapies, particularly with granulocyte colony-stimulating factor (GCSF), has become a lucrative option for improving transplant-free survival. However, the literature is confusing with regards to patient selection and real outcomes. In this exhaustive review, we describe the basics of liver fibrosis and cirrhosis through novel insights from a therapeutic point of view, discuss preclinical studies on GCSF in advanced liver disease to improve on clinical utility, shed light on the pertinent literature of GCSF in advanced cirrhosis, and provide astute inputs on growth factor therapy in decompensated cirrhosis.

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Section: Critical Appraisal Of Gcsf In Decompensated Cirrhosismentioning

confidence: 99%

Section: Critical Appraisal Of Gcsf In Decompensated Cirrhosismentioning

confidence: 99%

Role of Granulocyte Colony-stimulating Factor Therapy in Cirrhosis, ‘Inside Any Deep Asking Is the Answering’

Philips¹,

Augustine²,

Ahamed³

et al. 2019

Journal of Clinical and Translational Hepatology

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“…[10][11] G-CSF has shown to improve short-term survival and clinical outcomes in Alcoholic Hepatitis 12 , ACLF 13 and Decompensated CLD. 14 Immune paralysis leads to sepsis and hence Hepato-Renal Syndrome (HRS) and Hepatic Encephalopathy (HE) in patients with cirrhosis. 15 G-CSF has been shown to improve immune function in patients of liver disease.…”

Section: Introductionmentioning

confidence: 99%

“…GCSF therapy also improves both the chances of survival and the clinical outcome in patients with decompensated cirrhosis. 14 Hence, in this pilot study we tried to see if there is any benefit of GCSF in overall chronic liver disease patients, in terms of mortality within one month of hospital admission and improvement in CTP and MELD scores, irrespective of their stage and presentation…”

Section: Introductionmentioning

confidence: 99%

Use of Granulocyte Colony-Stimulating Factor Among Patients of Chronic Liver Disease in a Tertiary Hospital in Nepal: A Pilot Study

Pathak

Thapaliya

2019

Med. J. Shree Birendra Hosp.

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Introduction: Granulocyte colony stimulating factor improves short-term survival and clinical outcomes in alcoholic hepatitis, acute-on-chronic liver failure and decompensated chronic liver disease. Our study aimed to assess survival benefit and change in Child-Turcotte-Pugh and Model For End-Stage Liver Disease scores 30 days after Granulocyte colony stimulating factor therapy in chronic liver disease patients, irrespective of their mode of presentation. Methods: This was a prospective observational study conducted in a university teaching hospital, where 25 patients with chronic liver disease were given 300 micrograms of Granulocyte colony stimulating factor subcutaneously 12 hourly plus standard medical therapy. We assessed survival until day 30. Child-Turcotte- Pugh and Model For End-Stage Liver Disease scores at enrolment and 30 days after treatment were compared. Results: 21 of 25 patients treated with Granulocyte colony stimulating factor survived at day 30. Treatment with Granulocyte colony stimulating factor reduced Child-Turcotte-Pugh score from 10.33 ± 1.24 to 8.76 ± 1.79 (p< 0.001) at day 30 and Model For End-Stage Liver Disease score from 22.10 ± 4.67 to 16.38 ± 5.52 (p < 0.001) at day 30. Conclusions: Granulocyte colony stimulating factor improves clinical outcome, Child-Turcotte-Pugh and Model For End-Stage Liver Disease scores in patients admitted with chronic liver disease for any cause. Further studies are needed to explore whether lower doses (total six doses) of Granulocyte colony stimulating factor are as effective as higher doses (total 10 doses).

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“…( 22,23 ) Clinical trials treating patients with compensated and decompensated cirrhosis with G‐CSF demonstrate contradictory results. ( 23‐27 )…”

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confidence: 99%

Loss of Coordinated Neutrophil Responses to the Human Fungal Pathogen, Candida albicans, in Patients With Cirrhosis

et al. 2021

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Neutrophils are the most abundant white blood cell in the body and are key participants in the defense against fungal infections. Fungal infections occur often in patients with cirrhosis and are associated with increased 30‐day and 90‐day mortality. Previous studies have shown that specific neutrophil functions are abnormal in patients with cirrhosis, although the extent of neutrophil dysfunction is not well understood. We tested the ability of neutrophils from 21 hospitalized patients with cirrhosis and 23 healthy control patients to kill Candida albicans, a common fungal pathogen in patients with cirrhosis. Using an assay, we also measured the ability of neutrophils to coordinate multicellular, synchronized control of C. albicans hyphae through a process known as swarming. We found that neutrophils from patients with cirrhosis have significantly decreased fungicidal capacity compared with healthy control neutrophils (53% vs. 74%, P < 0.0001) and diminished ability to control hyphal growth normalized as a ratio to healthy control (0.22 vs. 0.65, P < 0.0001). Moreover, serum from patients with cirrhosis decreases the ability of healthy control neutrophils to kill C. albicans (from 60% to 41%, P < 0.003). Circulating concentration of the inflammatory cytokines tumor necrosis factor α, interleukin‐6, and interleukin‐8 were found to be significantly elevated in patients with cirrhosis compared to healthy controls. Following pretreatment with granulocyte‐colony stimulating factor and granulocyte‐macrophage colony‐stimulating factor, neutrophil function was restored to almost that of healthy controls. Conclusion: Our data establish profound neutrophil dysfunction against, and altered swarming to, C. albicans in patients with cirrhosis. This dysfunction can be partially reversed with cytokine augmentation ex vivo.

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Granulocyte colony-stimulating factor improves survival of patients with decompensated cirrhosis: a randomized-controlled trial

Cited by 35 publications

References 29 publications

Role of Granulocyte Colony-stimulating Factor Therapy in Cirrhosis, ‘Inside Any Deep Asking Is the Answering’

Role of Granulocyte Colony-stimulating Factor Therapy in Cirrhosis, ‘Inside Any Deep Asking Is the Answering’

Use of Granulocyte Colony-Stimulating Factor Among Patients of Chronic Liver Disease in a Tertiary Hospital in Nepal: A Pilot Study

Loss of Coordinated Neutrophil Responses to the Human Fungal Pathogen, Candida albicans, in Patients With Cirrhosis

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