Recombinant human growth hormone treatment in pediatric burn patients and its role during the hepatic acute phase response

Citation
Mg. Jeschke et al., Recombinant human growth hormone treatment in pediatric burn patients and its role during the hepatic acute phase response, CRIT CARE M, 28(5), 2000, pp. 1578-1584
Citations number
55
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
CRITICAL CARE MEDICINE
ISSN journal
00903493 → ACNP
Volume
28
Issue
5
Year of publication
2000
Pages
1578 - 1584
Database
ISI
SICI code
0090-3493(200005)28:5<1578:RHGHTI>2.0.ZU;2-J
Abstract
Objective: Recombinant human growth hormone (rHGH) has been shown to increa se mortality in adult trauma patients; however, little has been reported on its side effects in children. The acute phase response has been suggested to he a contributing factor to trauma mortality. Therefore, the purpose of this study was to examine the effects of exogenous rHGH on the acute phase response in pediatric burn patients. Design: Prospective, randomized, double-blind study. Setting: Shriners Hospital for Children. Patients: Thermally injured pediatric patients, ranging in age from 0.1 to 16 yrs. Interventions: Twenty-eight thermally injured children received either 0.2 mg/kg/day of rHGH or saline (placebo) within 3 days of admission and for at least 25 days. Measurements and Main Results: Measurements were patient demographics, inci dence of sepsis, inhalation injury, mortality, serum constitutive proteins, acute phase proteins, proinflammatory cytokines and insulin-like growth fa ctor-I (IGF-l), insulin-like growth factor binding protein (IGFBP)-1, and I GFBP-3. No differences could be demonstrated in age, gender, burn size, inc idence in sepsis (20% vs. 26%), inhalation injury (46% vs. 27%), or mortali ty (8% vs. 7%) between those receiving rHGH or placebo. Serum IGF-l and IGF BP-3 increased with rHGH treatment, whereas serum IGFBP-1 decreased compare d with placebo (p < .05), Burned children treated with rHGH required signif icantly less albumin substitution to maintain normal levels compared with p lacebo (p < .05). Those receiving rHGH demonstrated a decrease in serum C-r eactive protein and serum amyloid-A and an increase in serum retinol-bindin g protein compared with placebo (p < .05). rHGH decreased serum tumor necro sis factor-alpha and interleukin (IL)-1 beta, whereas no changes were found for serum IL-1 alpha, IL-6, and IL-10 compared with placebo (p <.05). Free fatty acids were elevated in burned children who received rHGH (p < .05). Conclusion: Data indicate that rHGH does not increase mortality. rHGH decre ased acute phase proteins, tumor necrosis factor-alpha, and IL-1 beta, whic h is associated with increases in constitutive hepatic proteins and IGF-l.