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Kenneth A. Kudsk, MD; Christine Mowatt-Larssen, PharmD; Julie Bukar, RD; Timothy Fabian, MD; Sherryl Oellerich, RN; Daniel L. Dent, MD; Rex Brown, PharmD

Arch Surg. 1994;129(1):66-71.

Abstract
Objective
To determine the effects of insulin-like growth factor I (IGF-I) and aggressive nutrition on CD4/CD8 ratios following head injury.

Design
Randomized controlled trial.

Setting
An urban level 1 trauma center.

Participants
Head-injured patients with a Glasgow Coma Scale score of 4 to 10 within 6 hours of hospital admission requiring no major extracranial surgery with the exception of isolated lower-extremity fracture fixation. Fourteen patients were recruited and 11 completed the study.

Interventions
Patients were randomized to a continuous infusion of saline or 0.01 mg/kg per hour of recombinant human (rh) IGF-I. Both groups received parenteral nutrition and rapidly advanced to a total protein intake of 2 g/kg per day and a maximum nonprotein calorie intake of 40 kcal/kg per day. The nonprotein prescription was 1.25 times the metabolic energy expenditure determined by metabolic cart not to exceed a nonprotein calorie intake of 40/kcal.

Main Outcome Measures
The CD4/CD8 ratios and serum IGF-I levels on days 1, 7, and 14.

Results
Administration of early aggressive nutrition eliminated the depressed CD4/CD8 ratio usually seen after head injury; administration of IGF-I increased the CD4/CD8 ratio while IGF-I levels were elevated.

Conclusions
Infusion of rhIGF-I and aggressive early intravenous nutrition affects the immunologic response of patients with severe head injury.

(Arch Surg. 1994;129:66-71)

Author Affiliations
From the Departments of Surgery (Drs Kudsk, Fabian, and Dent and Ms Oellerich) and Clinical Pharmacy (Dr Brown), the University of Tennessee, Memphis; Albany (NY) College of Pharmacy (Dr Mowatt-Larssen); and Genentech Inc, South San Francisco, Calif (Ms Bukar).

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