BACKGROUND: Circulating levels of GH are increased during critical illness and correlate with outcome in children with meningococcal sepsis. We assessed the prognostic implications of GH on admission and during follow-up in critically ill adult patients admitted to a medical intensive care unit. MATERIALS AND METHODS: We measured GH, IGF1 and IGF-binding protein3 (IGFBP-3) plasma concentrations in 103 consecutive critically ill patients and compared it with two clinical severity scores (APACHE II, SAPS II). RESULTS: Median GH levels on admission were similar in septic (n=53) and non-septic (n=50) patients and about 7-fold increased in the 24 non-survivors as compared with survivors (9.50 (interquartile ranges (IQR) 3.53-18.40) vs 1.4 (IQR 0.63-5.04), P<0.0001). GH levels increased with increasing severity of sepsis (sepsis, severe sepsis, and septic shock, P=0.019). By contrast, IGF1 and IGFBP-3 did not correlate with severity of disease or mortality. Logistic regression models showed that GH and both clinical scores were independent predictors of mortality with a similar prognostic accuracy (GH: area under the curve (AUC) 0.81 (95% confidence interval (CI), 0.71-0.92), APACHE II: AUC 0.71 (95% CI, 0.58-0.83), P=0.16, SAPS II: AUC 0.75 (95% CI, 0.63-0.86, P=0.36)). GH improved the prognostic accuracy of the APACHE II score to an AUC of 0.78 (95% CI, 0.66-090, P=0.04) and tended to improve the SAPS II score to an AUC of 0.79 (95% CI, 0.67-0.90, P=0.09). CONCLUSION: GH plasma concentrations on admission are independent predictors for mortality in adult critically ill patients and may complement existing risk prediction scores, namely the APACHE II and the SAPS II score.
BACKGROUND: Circulating levels of GH are increased during critical illness and correlate with outcome in children with meningococcal sepsis. We assessed the prognostic implications of GH on admission and during follow-up in critically ill adult patients admitted to a medical intensive care unit. MATERIALS AND METHODS: We measured GH, IGF1 and IGF-binding protein3 (IGFBP-3) plasma concentrations in 103 consecutive critically ill patients and compared it with two clinical severity scores (APACHE II, SAPS II). RESULTS: Median GH levels on admission were similar in septic (n=53) and non-septic (n=50) patients and about 7-fold increased in the 24 non-survivors as compared with survivors (9.50 (interquartile ranges (IQR) 3.53-18.40) vs 1.4 (IQR 0.63-5.04), P<0.0001). GH levels increased with increasing severity of sepsis (sepsis, severe sepsis, and septic shock, P=0.019). By contrast, IGF1 and IGFBP-3 did not correlate with severity of disease or mortality. Logistic regression models showed that GH and both clinical scores were independent predictors of mortality with a similar prognostic accuracy (GH: area under the curve (AUC) 0.81 (95% confidence interval (CI), 0.71-0.92), APACHE II: AUC 0.71 (95% CI, 0.58-0.83), P=0.16, SAPS II: AUC 0.75 (95% CI, 0.63-0.86, P=0.36)). GH improved the prognostic accuracy of the APACHE II score to an AUC of 0.78 (95% CI, 0.66-090, P=0.04) and tended to improve the SAPS II score to an AUC of 0.79 (95% CI, 0.67-0.90, P=0.09). CONCLUSION: GH plasma concentrations on admission are independent predictors for mortality in adult critically ill patients and may complement existing risk prediction scores, namely the APACHE II and the SAPS II score.
Authors: Amy M Ahasic; Rihong Zhai; Li Su; Yang Zhao; Konstantinos N Aronis; B Taylor Thompson; Christos S Mantzoros; David C Christiani Journal: Eur J Endocrinol Date: 2011-10-17 Impact factor: 6.664
Authors: Itoro E Elijah; Ludwik K Branski; Celeste C Finnerty; David N Herndon Journal: Best Pract Res Clin Endocrinol Metab Date: 2011-10 Impact factor: 4.690
Authors: Amy M Ahasic; Paula Tejera; Yongyue Wei; Li Su; Christos S Mantzoros; Ednan K Bajwa; B Taylor Thompson; David C Christiani Journal: Crit Care Med Date: 2015-12 Impact factor: 7.598
Authors: Philipp Schuetz; Pierre Hausfater; Devendra Amin; Sebastian Haubitz; Lukas Fässler; Eva Grolimund; Alexander Kutz; Ursula Schild; Zeljka Caldara; Katharina Regez; Andriy Zhydkov; Timo Kahles; Krassen Nedeltchev; Stefanie von Felten; Sabina De Geest; Antoinette Conca; Petra Schäfer-Keller; Andreas Huber; Mario Bargetzi; Ulrich Buergi; Gabrielle Sauvin; Pasqualina Perrig-Chiello; Barbara Reutlinger; Beat Mueller Journal: BMC Emerg Med Date: 2013-07-04