TY - JOUR
T1 - Granulocyte-Colony Stimulating Factor Improves Neurological and Functional Outcomes in Patients With Traumatic Incomplete Spinal Cord Injuries
T2 - A Systematic Review With Meta-Analyses
AU - Weisbrod, Luke J.
AU - Nilles-Melchert, Thomas T.
AU - Bergjord, Judith R.
AU - Surdell, Daniel L.
N1 - Publisher Copyright:
© Luke J. Weisbrod et al., 2024; Published by Mary Ann Liebert, Inc.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - Spinal cord injury (SCI) is a cause for significant morbidity, often resulting in long-term disability. We compared outcomes after administration of granulocyte-colony stimulating factor (G-CSF) versus controls. MEDLINE, Embase, and Cochrane Library database searches yielded 222 records; six met study inclusion criteria. Fixed-effect and random-effects models were used to establish odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) for each outcome. The results of the pooled analysis showed that in patients with incomplete SCI, G-CSF resulted in increased American Spinal Cord Injury Association (ASIA) motor scores at 3 months (MD = 0.57 [95% CI = 0.04, 1.10], I2 = 63.84%, p = 0.036), 6 months (MD = 4.18 [95% CI = 0.55, 7.80], I2 = 98.75%, p = 0.024), change in ASIA pinprick scores at 6 months (MD = 3.38 [95% CI = 1.48, 5.28], I2 = 89.78%, p < 0.001), and increased Spinal Cord Independence Measure (SCIM) III score at 6 months (MD = 3.27 [95% CI = 1.13, 5.41], I2 = 91.86%, p = 0.003). G-CSF resulted in more adverse events than the non-MP control groups (OR = 1.44 [95% CI = 0.38, 2.50], I2 = 0%, p = 0.008), but fewer than the MP control groups (OR = −4.2 [95% CI = −5.72, −2.68], I2 = 0%, p < 0.001). Systemic white blood cell count increased after administration of G-CSF in comparison to baseline (MD = 3.57 [95% CI = 2.79, 4.35], I2 = 55.06%, p < 0.001). G-CSF did not statistically increase ASIA Impairment Scale at 3 months (MD = 0.48 [95% CI = −0.33, 1.28], I2 = 0%, p = 0.246) or at 6 months (MD = 1.84 [95% CI = −0.10, 3.79], I2 = 50.09%, p = 0.063). These meta-analyses of six studies suggest that G-CSF for the treatment of incomplete SCI may result in improved neurological outcomes when compared to the controls. The results are limited by a small sample size with heterogeneity between studies. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of G-CSF.
AB - Spinal cord injury (SCI) is a cause for significant morbidity, often resulting in long-term disability. We compared outcomes after administration of granulocyte-colony stimulating factor (G-CSF) versus controls. MEDLINE, Embase, and Cochrane Library database searches yielded 222 records; six met study inclusion criteria. Fixed-effect and random-effects models were used to establish odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) for each outcome. The results of the pooled analysis showed that in patients with incomplete SCI, G-CSF resulted in increased American Spinal Cord Injury Association (ASIA) motor scores at 3 months (MD = 0.57 [95% CI = 0.04, 1.10], I2 = 63.84%, p = 0.036), 6 months (MD = 4.18 [95% CI = 0.55, 7.80], I2 = 98.75%, p = 0.024), change in ASIA pinprick scores at 6 months (MD = 3.38 [95% CI = 1.48, 5.28], I2 = 89.78%, p < 0.001), and increased Spinal Cord Independence Measure (SCIM) III score at 6 months (MD = 3.27 [95% CI = 1.13, 5.41], I2 = 91.86%, p = 0.003). G-CSF resulted in more adverse events than the non-MP control groups (OR = 1.44 [95% CI = 0.38, 2.50], I2 = 0%, p = 0.008), but fewer than the MP control groups (OR = −4.2 [95% CI = −5.72, −2.68], I2 = 0%, p < 0.001). Systemic white blood cell count increased after administration of G-CSF in comparison to baseline (MD = 3.57 [95% CI = 2.79, 4.35], I2 = 55.06%, p < 0.001). G-CSF did not statistically increase ASIA Impairment Scale at 3 months (MD = 0.48 [95% CI = −0.33, 1.28], I2 = 0%, p = 0.246) or at 6 months (MD = 1.84 [95% CI = −0.10, 3.79], I2 = 50.09%, p = 0.063). These meta-analyses of six studies suggest that G-CSF for the treatment of incomplete SCI may result in improved neurological outcomes when compared to the controls. The results are limited by a small sample size with heterogeneity between studies. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of G-CSF.
KW - granulocyte-colony stimulating factor
KW - spinal cord injury
KW - trauma
UR - http://www.scopus.com/inward/record.url?scp=85192863390&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85192863390&partnerID=8YFLogxK
U2 - 10.1089/neur.2023.0099
DO - 10.1089/neur.2023.0099
M3 - Article
C2 - 39582880
AN - SCOPUS:85192863390
SN - 2689-288X
VL - 5
SP - 467
EP - 482
JO - Neurotrauma Reports
JF - Neurotrauma Reports
IS - 1
ER -