Neurotrauma Reports (May 2024)

Granulocyte-Colony Stimulating Factor Improves Neurological and Functional Outcomes in Patients With Traumatic Incomplete Spinal Cord Injuries: A Systematic Review With Meta-Analyses

  • Luke J. Weisbrod,
  • Thomas T. Nilles-Melchert,
  • Judith R. Bergjord,
  • Daniel L. Surdell

DOI
https://doi.org/10.1089/NEUR.2023.0099
Journal volume & issue
Vol. 5, no. 1
pp. 467 – 482

Abstract

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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.

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