EFFECT OF RECOMBINANT HUMAN INSULIN-LIKE GROWTH-FACTOR-I AND EARLY TOTAL PARENTERAL-NUTRITION ON IMMUNE DEPRESSION FOLLOWING SEVERE HEAD-INJURY

Objective: To determine the effects of insulin-like growth factor I (I GF-I) and aggressive nutrition on CD4/CD8 ratios following head injury . Design: Randomized controlled trial. Setting: An urban level 1 traum a center. Participants: Head-injured patients with a Glasgow Coma Scal e score of 4 to 10 within 6 hours of hospital admission requiring no m ajor extracranial surgery with the exception of isolated lower-extremi ty fracture fixation. Fourteen patients were recruited and 11 complete d the study. Interventions: Patients were randomized to a continuous i nfusion of saline or 0.01 mg/kg per hour of recombinant human (rh) IGF -I. Both groups received parenteral nutrition and rapidly advanced to a total protein intake of 2 g/kg per day and a maximum nonprotein calo rie intake of 40 kcal/kg per day. The nonprotein prescription was 1.25 times the metabolic energy expenditure determined by metabolic cart n ot to exceed a nonprotein calorie intake of 40/kcal. Main Outcome Meas ures: The CD4/CD8 ratios and serum IGF-I levels on days 1, 7, and 14. Results: Administration of early aggressive nutrition eliminated the d epressed CD4/CD8 ratio usually seen after head injury; administration of IGF-I increased the CD4/CD8 ratio while IGF-I levels were elevated. Conclusions: Infusion of rhIGF-I and aggressive early intravenous nut rition affects the immunologic response of patients with severe head i njury.