Granulocyte Colony-Stimulating Factor Use in Decompensated Cirrhosis: Lack of Survival Benefit.

Autor: Philips CA; The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala., Augustine P; Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala., Rajesh S; Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala., Ahamed R; Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala., George T; Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala., Padsalgi G; Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala., Paramaguru R; Pathology, PVS Memorial Hospital, Kochi, Kerala., Valiathan G; Gastrointestinal and Hepatobiliary Surgery, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala., John SK; Hepatobiliary and Transplant Surgery, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala.
Jazyk: angličtina
Zdroj: Journal of clinical and experimental hepatology [J Clin Exp Hepatol] 2020 Mar-Apr; Vol. 10 (2), pp. 124-134. Date of Electronic Publication: 2019 Jun 01.
DOI: 10.1016/j.jceh.2019.05.003
Abstrakt: Background: Granulocyte colony-stimulating factor (GCSF) has been utilized in decompensated cirrhosis (DC) for improving transplant-free survival (TFS). Data from multiple centers are conflicting with regard to patient outcomes. In this retrospective study, we present our 'real-world experience' of GCSF use in a large group of DC.
Methods: From September 2016 to September 2018, 1231 patients with cirrhosis were screened, of which 754 were found to have decompensation(s). Seventy-three patients with active ascites, jaundice, or both completed GCSF treatment (10 mcg/kg per day for 5 days, followed by 5 mcg/kg/day once every third day for total 12 doses). Per-protocol analysis (n = 56) was performed to study clinical events, liver disease severity, and outcomes at 3, 6, and 12 months after treatment. Modified intention-to-treat (mITT, n = 100) analysis was performed to study overall survival at 180 days. Outcomes were compared with a matched historical control (HC) group (n = 24).
Results: Nine (16%, n = 56), 24 (43%, n = 56), and 36 (75%, n = 48) patients died at 3, 6, and 12-month follow-up after GCSF. The commonest cause of death was sepsis (53%) followed by progressive liver failure (33%). Nine percent of patients developed hepatocellular carcinoma on follow-up at the end of 1 year. Acute variceal bleeds, overt hepatic encephalopathy, intensive unit admissions, and liver disease severity scores were higher after treatment at the end of 1 year. The Child-Pugh score >11 and model for end-stage liver disease-sodium score >25 and > 20 predicted worse outcomes at all time points and at 6 and 12 months after GCSF, respectively. Compared to a matched HC group, patients receiving GCSF had higher mortality (75% vs 46%, P  = 0.04) at one year. mITT analysis revealed poor overall survival at 6 months compared to HCs (48% vs 75%, P  = 0.04).
Conclusion: Survival in DC was shorter than what was expected in the natural history of the disease after GCSF use.
(© 2019 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: