Objective: To systematically assess the effects and safety of granulocyte-monocyte colony-stimulating factor (GM-CSF) in the treatment of sepsis.
Methods: All randomized controlled trials (RCTs) of GM-CSF for the treatment of sepsis were retrieved from the databases, including PubMed (1966-2009.10), EMbase (1974-2009.10), Cochrane Clinical Trials Library (Issue 4, 2009), China Biomedicine Literature Database (CBM, 1978-2009.10), Weipu (VIP, 1989-2009.10), China National Knowledge Internet (CNKI, 1994-2009.10) and Wanfang Database (1997-2009.10). The quality of the included RCTs was assessed with the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0. The Cochrane Collaboration's software RevMan 5.0 was used for Meta-analysis.
Results: Four RCTs (154 patients) were included. Meta-analysis showed that there was no significant difference between the GM-CSF treatment and traditional therapy regarding 28-day mortality rate [relative risk (RR)=0.63, 95% confidence interval (95%CI) 0.27-1.45, P=0.28]. Meta-analysis also showed that there was no significant difference in the rate of adverse events (RR=0.89, 95%CI 0.342.33, P=0.82). Descriptive analysis showed that GM-CSF could improve immuno-suppression, reduce the complications of infection and shorten the duration of mechanical ventilation, but there was no difference in length of stay in hospital or intensive care unit (ICU) and sepsis-related organ failure assessment (SOFA) score.
Conclusion: The current evidence shows that, compare with the conventional therapy the GM-CSF has the benefit of improving immune function, reducing the complications of infection, and shortening the duration of mechanical ventilation. However, there is no difference in reducing mortality and adverse event, or shortening the length of stay in hospital or ICU and SOFA score with the use of GM-CSF.