Effect of recombinant human insulin-like growth factor I and early total parenteral nutrition on immune depression following severe head injury
K. A. Kudsk, C. Mowatt-Larssen, J. Bukar, T. Fabian, S. Oellerich, D. L. Dent and R. Brown
Department of Surgery, University of Tennessee, Memphis.
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.
