Role of Granulocyte Colony Stimulating Factor on the Short-Term Outcome of Children with Acute on Chronic Liver Failure.
AVH, acute viral hepatitis
CTP, Child-Turcotte-Pugh
HEV, hepatitis E virus
acute-on-chronic liver failure
children
granulocyte colony–stimulating factor
Journal
Journal of clinical and experimental hepatology
ISSN: 0973-6883
Titre abrégé: J Clin Exp Hepatol
Pays: India
ID NLM: 101574137
Informations de publication
Date de publication:
Historique:
received:
20
05
2019
accepted:
16
10
2019
entrez:
15
5
2020
pubmed:
15
5
2020
medline:
15
5
2020
Statut:
ppublish
Résumé
Acute-on-chronic liver failure (ACLF) results in very high mortality in children. We aimed to evaluate the role of granulocyte colony-stimulating factor (GCSF) on short-term outcome of children with ACLF in a nontransplant unit. Children (aged > 1 year) diagnosed with ACLF over a 15 month period were randomised. Group A was given GCSF therapy along with standard medical care (SMC - details in supplementary data) and group B was given only SMC. The outcome was evaluated as survival at 30 and 60 days of therapy. Thirty-one children with ACLF were enrolled, with a mean age of 6.92 ± 4.3yrs. A total of 15 patients were randomised to group A and 16 to group B. The overall mortality was 54.83%. The intervention group showed survival rates of 80%, 66.67% and 53.3%, whereas the control group had survival rates of 43.75%, 37.5% and 37.5% at 14, 30 and 60 days, respectively. A significant survival benefit was noted on day 14 (p = 0.043) of therapy in group A with significant difference in Child-Turcotte-Pugh (CTP) and pediatric end-stage liver disease (PELD) scores in the two groups. After an initial rise in group A, the granulocyte counts fell to become comparable in the two groups by day 30 and 60, indicating that the effect of GCSF therapy wears off over time. There was no significant difference in the overall survival, median/mean CTP, PELD and MCS (Modified Cliff sequential organ failure assesment (SOFA)) scores on day 30 and 60. Mean (%) CD 34 + cells level showed a rise on day 7 in group A but was statistically insignificant. The present study shows that GCSF therapy at 5 mcg/kg/day for 5 days seems to be ineffective in improving the survival outcome on day 30 and 60 of therapy. Studies with larger number of children enrolled and longer duration of therapy are required. (CTRI/2017/11/010420).
Sections du résumé
BACKGROUND
BACKGROUND
Acute-on-chronic liver failure (ACLF) results in very high mortality in children. We aimed to evaluate the role of granulocyte colony-stimulating factor (GCSF) on short-term outcome of children with ACLF in a nontransplant unit.
METHODS
METHODS
Children (aged > 1 year) diagnosed with ACLF over a 15 month period were randomised. Group A was given GCSF therapy along with standard medical care (SMC - details in supplementary data) and group B was given only SMC. The outcome was evaluated as survival at 30 and 60 days of therapy.
RESULT
RESULTS
Thirty-one children with ACLF were enrolled, with a mean age of 6.92 ± 4.3yrs. A total of 15 patients were randomised to group A and 16 to group B. The overall mortality was 54.83%. The intervention group showed survival rates of 80%, 66.67% and 53.3%, whereas the control group had survival rates of 43.75%, 37.5% and 37.5% at 14, 30 and 60 days, respectively. A significant survival benefit was noted on day 14 (p = 0.043) of therapy in group A with significant difference in Child-Turcotte-Pugh (CTP) and pediatric end-stage liver disease (PELD) scores in the two groups. After an initial rise in group A, the granulocyte counts fell to become comparable in the two groups by day 30 and 60, indicating that the effect of GCSF therapy wears off over time. There was no significant difference in the overall survival, median/mean CTP, PELD and MCS (Modified Cliff sequential organ failure assesment (SOFA)) scores on day 30 and 60. Mean (%) CD 34 + cells level showed a rise on day 7 in group A but was statistically insignificant.
CONCLUSION
CONCLUSIONS
The present study shows that GCSF therapy at 5 mcg/kg/day for 5 days seems to be ineffective in improving the survival outcome on day 30 and 60 of therapy. Studies with larger number of children enrolled and longer duration of therapy are required. (CTRI/2017/11/010420).
Identifiants
pubmed: 32405176
doi: 10.1016/j.jceh.2019.10.001
pii: S0973-6883(19)30258-0
pmc: PMC7212291
doi:
Types de publication
Journal Article
Langues
eng
Pagination
201-210Informations de copyright
© 2019 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
The authors have none to declare.
Références
Gastroenterology. 2013 Jun;144(7):1426-37, 1437.e1-9
pubmed: 23474284
J Hematother. 1996 Jun;5(3):213-26
pubmed: 8817388
Crit Care. 2012 Nov 27;16(6):R227
pubmed: 23186071
Gut. 2017 Mar;66(3):541-553
pubmed: 28053053
J Gastroenterol Hepatol. 2017 Dec;32(12):1989-1997
pubmed: 28374414
Clin J Am Soc Nephrol. 2015 Apr 7;10(4):554-61
pubmed: 25649155
Liver Transpl. 2001 Jul;7(7):567-80
pubmed: 11460223
Indian Pediatr. 2013 Jul;50(7):677-9
pubmed: 23255683
J Pediatr Gastroenterol Nutr. 2016 Oct;63(4):400-5
pubmed: 26967824
J Pediatr. 2006 May;148(5):652-658
pubmed: 16737880
Liver Int. 2018 Oct;38(10):1777-1784
pubmed: 29325220
Scand J Gastroenterol. 2015 Jul;50(7):875-83
pubmed: 25697824
Hepatol Int. 2015 Jul;9(3):360-5
pubmed: 26016465
Hepatol Int. 2017 Nov;11(6):540-546
pubmed: 28840583
Hepatology. 2008 Jul;48(1):169-76
pubmed: 18537184
J Hepatol. 2015 Apr;62(1 Suppl):S131-43
pubmed: 25920082
J Pediatr Gastroenterol Nutr. 2012 Jan;54(1):77-82
pubmed: 21691224
Gastroenterology. 2012 Mar;142(3):505-512.e1
pubmed: 22119930
Liver Int. 2017 Oct;37(10):1508-1514
pubmed: 28111909
J Pediatr Gastroenterol Nutr. 2010 Feb;50(2):184-7
pubmed: 19966578
Lancet Gastroenterol Hepatol. 2018 Jan;3(1):25-36
pubmed: 29127060
J Trop Pediatr. 2002 Aug;48(4):210-3
pubmed: 12200981
J Gastroenterol Hepatol. 2006 Oct;21(10):1533-7
pubmed: 16928213
Indian Pediatr. 1999 Nov;36(11):1107-12
pubmed: 10745331
Sci Rep. 2016 May 05;6:25487
pubmed: 27146801
Hepatol Int. 2014 Oct;8(4):453-71
pubmed: 26202751
World J Gastroenterol. 2013 Feb 21;19(7):1104-10
pubmed: 23467275
J Hepatol. 2012 Dec;57(6):1336-48
pubmed: 22750750
Hepatol Int. 2018 Nov;12(6):552-559
pubmed: 30341639
Hepatology. 2015 Jul;62(1):232-42
pubmed: 25800029
Hepatol Int. 2011 Jun;5(2):693-7
pubmed: 21484110
Ann Hepatol. 2015 Sep-Oct;14(5):631-41
pubmed: 26256891
Pediatr Crit Care Med. 2005 Jan;6(1):2-8
pubmed: 15636651
J Clin Exp Hepatol. 2016 Mar;6(1):26-32
pubmed: 27194893
Indian J Pediatr. 1999;66(1 Suppl):S97-103
pubmed: 11138559
Nat Rev Gastroenterol Hepatol. 2016 Mar;13(3):131-49
pubmed: 26837712
Orv Hetil. 2012 Dec 9;153(49):1948-57
pubmed: 23204301
J Clin Microbiol. 2011 Sep;49(9):3422-4
pubmed: 21734024
Hepat Res Treat. 2013;2013:472027
pubmed: 24232179
Hepatology. 2014 Jul;60(1):250-6
pubmed: 24677131
J Hepatol. 2012 Mar;56(3):671-85
pubmed: 22340672