Granulocyte colony-stimulating factor in severe alcoholic hepatitis: a randomized pilot study

Am J Gastroenterol. 2014 Sep;109(9):1417-23. doi: 10.1038/ajg.2014.154. Epub 2014 Jun 17.


Objectives: Severe alcoholic hepatitis has high short-term mortality. The aim of this study was to test the hypothesis that treatment of patients with alcoholic hepatitis with granulocyte colony-stimulating factor (G-CSF) might mobilize bone marrow-derived stem cells and promote hepatic regeneration and thus improve survival.

Methods: Forty-six patients with severe alcoholic hepatitis were prospectively randomized in an open study to standard medical therapy (SMT) plus G-CSF (group A; n=23) at a dose of 5 μg/kg subcutaneously every 12 h for 5 consecutive days or to SMT alone (group B; n=23) at a tertiary care center. We assessed the mobilization of CD34(+) cells on day 6, Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), and modified Maddrey's discriminant function (mDF) scores, and survival until day 90.

Results: There was a statistically significant increase in the number of CD34(+) cells in peripheral blood in group A as compared with group B (P=0.019) after 5 days of G-GSF therapy. There was a significant reduction in median Δ change% in CTP, MELD, and mDF at 1, 2, and 3 months in group A as compared with group B (P<0.05). There was marked improvement in survival in group A as compared with group B (78.3% vs. 30.4%; P=0.001) at 90 days.

Conclusions: G-CSF is safe and effective in the mobilization of hematopoietic stem cells and improves liver function as well as survival in patients with severe alcoholic hepatitis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Alanine Transaminase / blood
  • Alkaline Phosphatase / blood
  • Antigens, CD34 / analysis
  • Bilirubin / blood
  • End Stage Liver Disease / etiology
  • Female
  • Granulocyte Colony-Stimulating Factor / adverse effects
  • Granulocyte Colony-Stimulating Factor / therapeutic use*
  • Hematopoietic Stem Cells / chemistry
  • Hematopoietic Stem Cells / drug effects*
  • Hepatitis, Alcoholic / blood
  • Hepatitis, Alcoholic / complications
  • Hepatitis, Alcoholic / drug therapy*
  • Humans
  • Leukocyte Count
  • Male
  • Middle Aged
  • Neutrophils*
  • Pilot Projects
  • Prospective Studies
  • Severity of Illness Index
  • Survival Rate


  • Antigens, CD34
  • Granulocyte Colony-Stimulating Factor
  • Alanine Transaminase
  • Alkaline Phosphatase
  • Bilirubin