Critical illness is associated with low circulating concentrations of insulin-like growth factors-I and -II, alterations in insulin-like growth factor binding proteins, and induction of an insulin-like growth factor binding protein 3 protease

Abstract

Critical illness is associated with low circulating concentrations of insulin-like growth factor-I, insulin-like growth factor-II, and insulin-like growth factor binding protein 3 and these low values are associated with induction of protease activity specifically directed against insulin-like growth factor binding protein 3. In survivors, recovery is associated with increasing insulin-like growth factor-I and insulin-like growth factor binding protein 3 concentrations and cessation of protease activity. The therapeutic effects of exogenous growth factors are likely to be influenced by these changes.

Metabolic effects of enteral versus parenteral alanyl-glutamine dipeptide administration in critically ill patients receiving enteral feeding: A pilot study

“…In this metabolic milieu, no differences in nitrogen balance between treatment groups occurred although the enteral AG group tended to have less nitrogen loss. Further, AG given by either route did not affect serum IGF-1 or IGF-BP3 levels, which mediate proteinanabolic processes in critical illness [16,30]. Thus, an important finding of our study is that short-term (8-day) Gln dipeptide administration (0.33 to 0.5 g/kg/day) by either enteral or parenteral routes did not attenuate body nitrogen loss in these clinically well-matched, catabolic patients requiring tube feeding.…”

“…At baseline and again at day 9, plasma concentrations of Gln, glutamate (Glu), alanine (Ala), GSH, vitamin C, α-tocopherol, γ-tocopherol, zinc, malondialdehyde (MDA; an index of oxidative stress via lipid peroxidation), glutathione peroxidase (GSHPX), total lymphocyte counts and lymphocyte subsets were measured as was intestinal barrier function to oral lactulose/mannitol. Serum concentrations of insulin-growth factor-1 (IGF-1) and IGF-binding protein-3 (IGF-BP3) were measured as mediators of the action of IGF-1, a major anabolic hormone which is decreased during catabolic illness [16]. A 3-day nitrogen balance study was performed between study days 6 to day 8.…”

Hormonal status in protracted critical illness and in-hospital mortality

“…Protracted critical illness is associated with dysfunction of the neuroendocrine axes and the adrenal gland [5,6,17,19-21], which is characterized by low circulating levels of hypophyseal and adrenal hormones, notably DHEA and DHEAS. In accord with our previous study [11], the present results are consistent with this endocrine pattern, indicating that hormonal status has been assessed at the postacute phase of critical illness.…”

“…To our knowledge, this postacute phase relationship has been assessed in only one small cohort study [6]. A low IGF-1 level is considered a valuable marker of growth hormone (GH) deficiency, which is considered deleterious [25] and has inspired clinical trials [26,27].…”

“…There is an extensive literature on the prognostic value of endocrinological markers in the acute phase of critical illness, in contrast to the prolonged phase. Most hormonal studies on protracted critical illness have either included a small or particular cohort [6] or assessed one endocrine axis [7]. Therefore, we assessed the relationships between various endocrine markers and in-hospital mortality in a large population of patients with protracted critical illness [8].…”