Granulocyte-colony stimulating factor (G-CSF) to treat hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF): results from a retrospective real-world study

Objective Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) has a high mortality rate due to severe liver function disorder, extremely poor liver regeneration capacity, and dysregulated immune responses, thus new treatment measures are urgently needed to improve the therapeutic effect. This study aimed to evaluate the effectiveness of Granulocyte-colony stimulating factor (G-CSF) treatment in HBV-ACLF. Methods The data of patients with HBV-ACLF admitted to West China Hospital from January 2022 to October 2023 were collected retrospectively. They were divided into control group and treatment group according to whether they had received additional G-CSF treatment. The survival outcomes at 30-day and 90-day were analyzed between two groups. The change of disease severity score and alpha fetoprotein (AFP) after 14 days of hospitalization were observed between two groups. The control group received standard medical therapy, while the G-CSF group received G-CSF at a dose of 5µg/kg once daily for six days on the basis of standard medical therapy. Results In this retrospective study, a total of 136 HBV-ACLF patients were divided into two groups, with 47 in the G-CSF group and 89 in the control group. The 30-day survival rate of patients receiving G-CSF treatment was 85.1%, compared to 71.9% in the control group ( P  = 0.084). The 90-day survival rate for patients receiving G-CSF treatment was 76.6%, while it was 59.6% for the control group ( P  = 0.047). Additionally, on the 14th day of hospitalization, patients receiving G-CSF treatment showed a more reduction in Model for End-Stage Liver Disease (MELD) score ( P  = 0.001) and Child-Turcotte-Pugh (CTP) score ( P  = 0.021) compared to the control group. The decrease in serum AFP in the control group was greater than that in the G-CSF group, although there was no statistical difference ( P  = 0.112). Conclusion G-CSF significantly improves the survival rate of HBV-ACLF patients and further promotes the recovery of liver function during hospitalization for ACLF.