- Email: [email protected]
Recombinant human growth hormone administration in multitrauma patients: effect on nitrogen balance
Poster abstracts 197
Catabolic conditions Endocrine dysfunction R e c o m b i n a n t h u m a n growth h o r m o n e a d m i n i s t r a t i o n in m u l t i t r a u m a patients: e f f e c t on nitrogen b a l a n c e D. Botsios ~, N. Pontikides 2, M. BitzanP, G. Koletsos 3, 1". Kaltsas 2, 1". C. Constantinidis 4, D. Rigos 3, G. E. Krassas 2 1Fourth Surgical Department, G. Papanikolaou Hospital, 2Endocrine Clinic, Panagia Hospital, 3Genera[ Intensive Care Unit, G. Papanikolaou Hospital and 4Laboratory of Hygiene and Epidemiology, University Thessaloniki, Thessaloniki, Greece
During the catabolic phase of severe injury, conventional nutritional support has proved to be ineffective in reversing the negative nitrogen balance and, consequently, in preventing tissue loss. The administration of anabolic agents, such as recombinant human growth hormone (GH), may be beneficial in this situation. The aim of this prospective, randomized study was to investigate the effect of GH administration on the nitrogen balance in multitrauma patients during the catabolic phase. Twelve multitrauma patients (mean age [± SD], 31.4 _+ 9.8 years; APACHE II score, 20.18 _+ 4.40), who were mechanically ventilated, were included in the study. Six of the patients (group A), selected at random, received GH treatment (Genotropin ®, Pharmacia & Upjohn, Stockholm, Sweden) for 14 days, the dose gradually being increased from 8 mg/day (24 IU/day) to 16 mg/day (48 IU/day). The remaining six patients received placebo and were used as controls (group B). All patients were hypercatabolic (nitrogen loss = 22.42 _+ 5.70 g/day). Treatment was started on the third day following hospital admission. In all 12 patients, nutritional support was started on the third day following hospital admission and was
intended to provide 110% of the resting energy expenditure (measured by indirect calorimetry) and 1.5 g of protein per kg body weight. Analysis of nitrogen balance was performed daily on each patient, as were measurements of morning serum levels of GH, insulin-like growth factor I (IGF-I) and IGF binding protein-3 (IGFBP-3). Prior to the initiation of treatment, no difference was found in the negative nitrogen balance between the two groups. Furthermore, 11o differences were found between the log GH, IGF-I and IGFBP-3 levels. After 14 days of treatment, group A patients had a cumulative nitrogen balance o f - 4 . 9 1 _+ 10.57 g/day (data from 65 collections of urine), and group B patients had a corresponding value o f - 1 2 . 0 6 ± 8.02 g/day (data from 62 collections of urine). This difference was statistically significant (P < 0.01). Group A patients also had higher log GH and IGF-I levels compared with the control group, whereas no differences in IGFBP-3 levels were found. This study indicates that the administration of GH therapy to multitrauma patients produces significant anabolic effects that might prove important in the future outcome of these patients.
The growth h o r m o n e - i n s u l i n . l i k e growth f a c t o r I ax,s in adults with i n f l a m m a t o r y bowel d,sease M. Tsch6p, H. Feldmeier, M. Kirisgil, C. D. Pflaum, G. Hartmann, C. Folwaczny, K. L6schke, C. J. Strasburger Innenstadt University Hospital, Munich, Germany
Growth retardation occurs in approximately 50% of children with inflammatory bowel disease (IBD); however, the pathophysiology of this complication is still unknown. Recently, elevated levels of interleukin 6 (IL-6) were shown to cause growth retardation via an impairment of the growth hormone (GH)-insulin-like growth factor I (IGF-I) axis in transgenic mice. I In the present study, 95 adults with IBD and 32 healthy controls were examined. The activity of IBD was assessed according to clinical symptom scores (CDM [Crohn's disease activity index] and CA/ [colitis activity
index]). Serum levels of GH, IGF-I, IGF-binding protein-3 (IGFBP-3) and GH-binding protein (GHBP) were measured by in-house fluorescence immunoassays. 1I-6 was measured using a commercial enzyme-linked immunosorbent assay. Statistical analyses were performed using the Kruskal-Wallis test, the Mann-Whitney U-test, and Spearman's correlation coefficient. Patients with a high activity of IBD (CDAI score > 200, CAI score > 4) were found to have significantly higher levels of GH and significantly lower levels of IGF-I, IGFBP-3 and GHBP, compared
Catabolic conditions Endocrine dysfunction R e c o m b i n a n t h u m a n growth h o r m o n e a d m i n i s t r a t i o n in m u l t i t r a u m a patients: e f f e c t on nitrogen b a l a n c e D. Botsios ~, N. Pontikides 2, M. BitzanP, G. Koletsos 3, 1". Kaltsas 2, 1". C. Constantinidis 4, D. Rigos 3, G. E. Krassas 2 1Fourth Surgical Department, G. Papanikolaou Hospital, 2Endocrine Clinic, Panagia Hospital, 3Genera[ Intensive Care Unit, G. Papanikolaou Hospital and 4Laboratory of Hygiene and Epidemiology, University Thessaloniki, Thessaloniki, Greece
During the catabolic phase of severe injury, conventional nutritional support has proved to be ineffective in reversing the negative nitrogen balance and, consequently, in preventing tissue loss. The administration of anabolic agents, such as recombinant human growth hormone (GH), may be beneficial in this situation. The aim of this prospective, randomized study was to investigate the effect of GH administration on the nitrogen balance in multitrauma patients during the catabolic phase. Twelve multitrauma patients (mean age [± SD], 31.4 _+ 9.8 years; APACHE II score, 20.18 _+ 4.40), who were mechanically ventilated, were included in the study. Six of the patients (group A), selected at random, received GH treatment (Genotropin ®, Pharmacia & Upjohn, Stockholm, Sweden) for 14 days, the dose gradually being increased from 8 mg/day (24 IU/day) to 16 mg/day (48 IU/day). The remaining six patients received placebo and were used as controls (group B). All patients were hypercatabolic (nitrogen loss = 22.42 _+ 5.70 g/day). Treatment was started on the third day following hospital admission. In all 12 patients, nutritional support was started on the third day following hospital admission and was
intended to provide 110% of the resting energy expenditure (measured by indirect calorimetry) and 1.5 g of protein per kg body weight. Analysis of nitrogen balance was performed daily on each patient, as were measurements of morning serum levels of GH, insulin-like growth factor I (IGF-I) and IGF binding protein-3 (IGFBP-3). Prior to the initiation of treatment, no difference was found in the negative nitrogen balance between the two groups. Furthermore, 11o differences were found between the log GH, IGF-I and IGFBP-3 levels. After 14 days of treatment, group A patients had a cumulative nitrogen balance o f - 4 . 9 1 _+ 10.57 g/day (data from 65 collections of urine), and group B patients had a corresponding value o f - 1 2 . 0 6 ± 8.02 g/day (data from 62 collections of urine). This difference was statistically significant (P < 0.01). Group A patients also had higher log GH and IGF-I levels compared with the control group, whereas no differences in IGFBP-3 levels were found. This study indicates that the administration of GH therapy to multitrauma patients produces significant anabolic effects that might prove important in the future outcome of these patients.
The growth h o r m o n e - i n s u l i n . l i k e growth f a c t o r I ax,s in adults with i n f l a m m a t o r y bowel d,sease M. Tsch6p, H. Feldmeier, M. Kirisgil, C. D. Pflaum, G. Hartmann, C. Folwaczny, K. L6schke, C. J. Strasburger Innenstadt University Hospital, Munich, Germany
Growth retardation occurs in approximately 50% of children with inflammatory bowel disease (IBD); however, the pathophysiology of this complication is still unknown. Recently, elevated levels of interleukin 6 (IL-6) were shown to cause growth retardation via an impairment of the growth hormone (GH)-insulin-like growth factor I (IGF-I) axis in transgenic mice. I In the present study, 95 adults with IBD and 32 healthy controls were examined. The activity of IBD was assessed according to clinical symptom scores (CDM [Crohn's disease activity index] and CA/ [colitis activity
index]). Serum levels of GH, IGF-I, IGF-binding protein-3 (IGFBP-3) and GH-binding protein (GHBP) were measured by in-house fluorescence immunoassays. 1I-6 was measured using a commercial enzyme-linked immunosorbent assay. Statistical analyses were performed using the Kruskal-Wallis test, the Mann-Whitney U-test, and Spearman's correlation coefficient. Patients with a high activity of IBD (CDAI score > 200, CAI score > 4) were found to have significantly higher levels of GH and significantly lower levels of IGF-I, IGFBP-3 and GHBP, compared