G-CSF-In Patients With Severe Alcohol-Associated Hepatitis: A Real-World Experience.

Area of Science:

• Hepatology
• Gastroenterology
• Critical Care Medicine

Background:

• Severe alcohol-associated hepatitis (SAH) presents a high short-term mortality risk.
• Corticosteroid non-responders face a 70-80% mortality rate within six months.
• Limited data exist on granulocyte colony-stimulating factor (G-CSF) efficacy in SAH, particularly in steroid non-responders.

Purpose of the Study:

• To evaluate the efficacy of G-CSF compared to standard medical therapy (SMT) and corticosteroids in patients with SAH.
• To assess the impact of G-CSF on 90-day overall survival and 6-month transplant-free survival.
• To compare the incidence of adverse events, such as gastrointestinal bleeding, between treatment groups.

Main Methods:

• A multicentre retrospective cohort study was conducted from January 2016 to November 2023.
• SAH was defined by specific bilirubin and INR levels, excluding other causes of hepatitis or biliary obstruction.
• Propensity score matching (1:1) was employed to control for confounding variables between G-CSF and SMT/corticosteroid groups.

Main Results:

• G-CSF was administered to a small fraction (1.11%) of SAH patients, with a higher frequency in White patients and those with more comorbidities.
• After propensity score matching, 90-day overall survival was significantly higher in the G-CSF group (88.31%) compared to SMT or corticosteroids (62.36% and 74.39%, respectively).
• G-CSF treatment resulted in better 6-month transplant-free survival and a lower incidence of gastrointestinal bleeding compared to corticosteroids.

Conclusions:

• G-CSF is underutilized in severe alcohol-associated hepatitis but demonstrates significant benefits.
• G-CSF improves 90-day survival in SAH patients and is non-inferior to corticosteroid therapy.
• G-CSF represents a viable and potentially safer treatment option for severe alcohol-associated hepatitis.