A0494 - Therapeutic Effect of Granulocyte Colony-Stimulating Factor Therapy for Acute-on-Chronic Liver Failure: A Meta-Analysis of Randomized Controlled Trials

Arsalan Zafar Iqbal, MBBS¹, Syed Sarmad Javaid, ², Adnan Zafar, MBBS³, Ahmed Mustafa Rashid, ², Ahmed Kamal Siddiqi, ⁴, Javaid Zafar, ⁵, Omar Rizwan, MBBS³, Yousaf Zafar, ^6
1FMH Lahore Medical College, Lahore, Punjab, Pakistan; ²Jinnah Sindh Medical University, Karachi, Sindh, Pakistan; ³CMH Lahore Medical College, Lahore, Punjab, Pakistan; ⁴Ziauddin Medical University, Karachi, Sindh, Pakistan; ⁵Lahore General Hospital, Lahore, Punjab, Pakistan; ⁶University of Mississippi Medical Center, Madison, MS

Introduction: Acute-on-chronic liver failure (ACLF) is a condition characterized by acute decompensation of chronic liver disease, accompanied by the failure of one or more extra-hepatic organs and high short-term mortality. Currently, liver transplantation is the only definitive treatment for ACLF but it is not beneficial to all patients due to limited donors, expensive procedure and high risk of adverse effects, so granulocyte stimulating factor (G-CSF) is considered as an alternative treatment. However, its therapeutic effectiveness is still debatable, so we aimed to conduct a meta-analysis to evaluate the clinical efficacy of G-CSF In patients with ACLF.

Methods: MEDLINE and SCOPUS were queried from inception till June 2022 for randomized controlled trials (RCTs), without any restriction. RCTs evaluating effects of G-CSF on survival rates and occurrence of infection in patients with ACLF were incorporated. The results were reported using a random-effects meta-analysis and the Mantel-Haenszel risk ratio (RR).The Subgroup analysis was done to investigate the influence of study-level factors such as study setting, population and etiology on the outcomes of interest.

Results: Thirteen studies (n = 13) were included in our meta-analysis. The total number of participants in our study was 913, and the median study duration was 3 months. Our pooled analysis demonstrates that G-CSF therapy significantly improved survival rates (RR 1.52; 95% CI 1.23 to 1.88; p = 0.0001; Figure 1) in patients with ACLD. In our subgroup analysis, G-CSF was found to be associated with an improved survival rate in patients with viral hepatitis (RR 1.47; 95% CI 1.27 to 1.69; p < 0.00001). In contrast, results for patients with alcoholic hepatitis were insignificant (RR 1.66; 95% CI 0.88 to 3.16; p< 0.12). Pooled analysis also showed that G-CSF therapy significantly reduces the occurrence rate of infection more than SMT (RR 0.58; 95% CI 0.39 to 0.86; p= 0.006). In the subgroup analysis for viral hepatitis patients, G-CSF therapy was also significantly beneficial in reducing the occurrence rate of infection (RR 0.56; 95% CI 0.35 to 0.89; p=0.01), but in patients with alcoholic hepatitis, results were insignificant (RR 0.55; 95% CI 0.31 to 0.99; p=0.05).

Discussion: Our findings indicate that G-CSF therapy is beneficial in improving survival rates and reducing the risk of infection in patients with ACLF. Hence, it can be used as an alternative treatment for patients with ACLF.



Disclosures:


Arsalan Zafar Iqbal, MBBS¹, Syed Sarmad Javaid, ², Adnan Zafar, MBBS³, Ahmed Mustafa Rashid, ², Ahmed Kamal Siddiqi, ⁴, Javaid Zafar, ⁵, Omar Rizwan, MBBS³, Yousaf Zafar, ⁶. A0494 - Therapeutic Effect of Granulocyte Colony-Stimulating Factor Therapy for Acute-on-Chronic Liver Failure: A Meta-Analysis of Randomized Controlled Trials, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.