Elevations in growth hormone and glucagon-like peptide-2 levels on admission are associated with increased mortality in trauma patients.

Matthew P Rowan,Darrick J Beckman,Kevin K Chung,Stephen M Cohn,Christopher E White,Claire L Isbell,Julie A Rizzo

doi:10.1186/s13049-016-0310-8

Abstract

BackgroundBurn and trauma patients present a clinical challenge due to metabolic derangements and hypermetabolism that result in a prolonged catabolic state with impaired healing and secondary complications, including ventilator dependence. Previous work has shown that circulating levels of growth hormone (GH) are predictive of mortality in critically ill adults, but few studies have examined the prognostic potential of GH levels in adult trauma patients.MethodsTo investigate the utility of GH and other endocrine responses in the prediction of outcomes, we conducted a prospective, observational study of adult burn and trauma patients. We evaluated the serum concentration of GH, insulin-like growth factor 1 (IGF-1), IGF binding protein 3 (IGFBP-3), and glucagon-like peptide-2 (GLP-2) weekly for up to 6 weeks in 36 adult burn and trauma patients admitted between 2010 and 2013.ResultsNon-survivors had significantly higher levels of GH and GLP-2 on admission than survivors.DiscussionThis study demonstrates that GH has potential as a predictor of mortality in critically ill trauma and burn patients. Future studies will focus on not only the role of GH, but also GLP-2, which was shown to correlate with mortality in this study with a goal of offering early, targeted therapeutic interventions aimed at decreasing mortality in the critically injured.ConclusionsGH and GLP-2 may have clinical utility for outcome prediction in adult trauma patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0310-8) contains supplementary material, which is available to authorized users.

Highlights

Burn and trauma patients present a clinical challenge due to metabolic derangements and hypermetabolism that result in a prolonged catabolic state with impaired healing and secondary complications, including ventilator dependence
Activation of the hypothalamus causes the release of growth hormone releasing hormone, which activates the pituitary to release GH that acts on a number of targets, such as fat and liver, to increase the
To evaluate the prognostic value of other endocrine hormones, this study examined changes in the concentrations of GH, insulin-like growth factor 1 (IGF-1), IGF binding protein 3 (IGFBP-3), and glucagon-like peptide-2 (GLP-2) in adult burn and trauma patients with severe injury

Summary

Introduction

Burn and trauma patients present a clinical challenge due to metabolic derangements and hypermetabolism that result in a prolonged catabolic state with impaired healing and secondary complications, including ventilator dependence. Burns, and critical illness affect millions of people every year and present a significant challenge to clinicians due to prolonged stays and metabolic derangements. The acute phase (5–10 days) is marked by an actively secreting anterior pituitary with an increase in GH levels and paradoxically decreased IGF-1 and IGFBP-3, secondary to GH resistance [9, 10]. Transition to the chronic phase is marked by a decrease in GH secretion, persistently low IGF-1 and IGFBP-3, and continued protein catabolism [9, 11,12,13]

Methods

Results

Conclusion