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Granulocyte-colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) for sepsis: a meta-analysis

Granulocyte-colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) for sepsis: a meta-analysis,10.1186/cc1003

Granulocyte-colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) for sepsis: a meta-analysis   (Citations: 3)
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Introduction  To investigate the effects of G-CSF or GM-CSF therapy in non-neutropenic patients with sepsis. Methods  A systematic literature search of Medline, Embase and Cochrane Central Register of Controlled Trials was conducted using specific search terms. A manual review of references was also performed. Eligible studies were randomized control trials (RCTs) that compared granulocyte-colony stimulating factor (G-CSF) or granulocyte-macrophage colony stimulating factor (GM-CSF) therapy with placebo for the treatment of sepsis in adults. Main outcome measures were all-cause mortality at 14 days and 28 days after initiation of G-CSF or GM-CSF therapy, in-hospital mortality, reversal rate from infection, and adverse events. Results  Twelve RCTs with 2,380 patients were identified. In regard to 14-day mortality, a total of 9 death events occurred among 71 patients (12.7%) in the treatment group compared with 13 events among 67 patients (19.4%) in the placebo groups. Meta-analysis showed there was no significant difference in 28-day mortality when G-CSF or GM-CSF were compared with placebo (relative risks (RR) = 0.93, 95% confidence interval (CI): 0.79 to 1.11, P = 0.44; P for heterogeneity = 0.31, I2 = 15%). Compared with placebo, G-CSF or GM-CSF therapy did not significantly reduce in-hospital mortality (RR = 0.97, 95% CI: 0.69 to 1.36, P = 0.86; P for heterogeneity = 0.80, I2 = 0%). However, G-CSF or GM-CSF therapy significantly increased the reversal rate from infection (RR = 1.34, 95% CI: 1.11 to 1.62, P = 0.002; P for heterogeneity = 0.47, I2 = 0%). No significant difference was observed in adverse events between groups (RR = 0.93, 95% CI: 0.70 to 1.23, P = 0.62; P for heterogeneity = 0.03, I2 = 58%). Sensitivity analysis by excluding one trial did not significantly change the results of adverse events (RR = 1.05, 95% CI: 0.84 to 1.32, P = 0.44; P for heterogeneity = 0.17, I2 = 36%). Conclusions  There is no current evidence supporting the routine use of G-CSF or GM-CSF in patients with sepsis. Large prospective multicenter clinical trials investigating monocytic HLA-DR (mHLA-DR)-guided G-CSF or GM-CSF therapy in patients with sepsis-associated immunosuppression are warranted.
Journal: Critical Care - CRIT CARE , vol. 15, no. 1, pp. 1-12, 2011
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    • ...A recent metaanalysis published in Critical Care [1] evaluated clinical eff ects of colony-stimulating factors in patients with severe sepsis/septic shock...
    • ...Such approaches include immuno stimulation with interferon-γ [11], selective extracorporeal reduction of immunodepressants [12], and medication with granulocyte-colony stimulating factor (G-CSF)/granulocyte-macrophage colony stimulating factor (GM-CSF) (summarized in [1]) . However, when analysing the available data on CSF therapy in sepsis, it seems impor tant that G-CSF and GM-CSF have distinct properties...
    • ...As demonstrated in the recent meta-analysis [1], a total of 12 placebo-controlled randomized controlled trials (RCTs; n = 2,380 patients) investigated the clinical eff ects of G-CSF (n = 8 RCTs) and GM-CSF (n = 4 RCTs) in patients with severe sepsis/septic shock...

    Joerg C Schefold. Immunostimulation using granulocyte- and granulocyte-macrophage colony...

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