Low insulin-like growth factor-1 and hypocholesterolemia as mortality predictors in acute kidney injury in the intensive care unit*

Abstract

To assess the role of insulin-like growth factor-1 and cholesterol as predictors of acute kidney injury mortality in intensive care unit patients. Prospective cohort study. Multidisciplinary adult intensive care unit (24 beds). Adult patients with acute kidney injury at intensive care unit admission for an 11-month period were considered and a total of 56 patients were admitted in the study. None. At intensive care unit admission serum insulin-like growth factor-1 (ng/mL), total cholesterol (mg/dL), albumin (g/dL), transferrin (mg/dL), total lymphocyte count, triceps skinfold thickness, arm muscle area, and Subjective Global Nutritional Assessment were evaluated. Insulin-like growth factor-1 was significantly lower in nonsurviving as compared with surviving patients (48.5 +/- 24.4 vs. 70.8 +/- 39.9; p = 0.044), as well as cholesterol (80.3 +/- 35.7 vs. 147.4 +/- 53.1; p < 0.001) and albumin (1.9 +/- 0.4 vs. 2.4 +/- 0.7; p = 0.018). Groups were similar regarding transferrin, lymphocyte, triceps skinfold thickness, arm muscle area, and subjective global nutritional assessment. A binary logistic regression model based on insulin-like growth factor-1 < or = median (50.6 ng/mL), presence of sepsis, oliguria, and cholesterol < or = median (96 mg/dL) identified insulin-like growth factor-1 (odds ratio = 7.73; 95% confidence interval 1.19-49.87; p = 0.032), sepsis (odds ratio = 7.28; 95% confidence interval 1.29-40.89; p = 0.024), oliguria (odds ratio = 8.7; 95% confidence interval 1.10-68.77; p = 0.040) and cholesterol (odds ratio = 10.94; 95% confidence interval 1.89-63.29; p = 0.008) as independent covariate for death. Decreased levels of insulin-like growth factor-1 and cholesterol were clearly related to higher mortality. The close correlation of insulin-like growth factor-1 with nutritional status, its serum stability, and short-half life makes it a suitable candidate for an early and sensitive marker for intensive care unit acute kidney injury mortality.