Anabolic effects of oxandrolone in critically ill burn victims

David W. Hart, Steven Wolf, David L. Chinkes, Peter I. Ramzy, Dennis Gore, David Herndon

Research output: Contribution to journalArticle

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Abstract

Introduction: Severe burn causes a hypermetabolic, catabolic state. Loss of body protein, mainly from muscle, causes weakness, impaired immune function and delayed healing. Oxandrolone is an oral steroid that has been used in cachectic cancer and AIDS patients as well as rehabilitating burn patients to restore muscle mass. We hypothesize oxandrolone may reverse muscle catabolism in cachectic, critically ill burn patients. Methods: Ten severely burned children were enrolled in a prospective cohort analytic series. All had received care without skin grafting at outside hospitals prior to transfer to our pediatric burn unit. Upon transfer, excision and grafting and nutritional supplementation were employed. Nutritional status was assessed by weekly prealbumin measurements. Muscle protein kinetics were determined using a stable phenylalanine isotope tracer. Initial studies were done 5-7 days after admission. Six subjects were studied before and after approximately 1 week of oxandrolone 0.1 mg/kg QD. Four subjects were used as time controls and studied at matched time points. T-tests were used for statistical comparison. Data are presented as mean±SEM. Results: The four time control and six oxandrolone subjects did not differ in age or TBSA burn (7.1±3 yrs vs. 6.5±1.3 yrs; 40±5% vs. 41±11%). The control group arrived 34±17 days after injury, and the oxandrolone group 25±5. Prealbumin levels were low on presentation in both groups (9.3±3.8 mg/dl control vs. 7.4±2.8 oxandrolone) and remained low after one week of standard enteral feeding (14±5.3 vs. 13.3±2.2) with no differences between groups. Muscle protein net balance improved 1±6 nmol PHE/min/100cc leg in controls vs. 67±18 in the oxandrolone group (p<0.05). The improved protein metabolism in oxandrolone subjects was accompanied by an increased protein synthetic efficiency determined by the percent of intracellular amino acids directed to protein synthesis (17±6% before, 37±5% after oxandrolone; p=0.05). Muscle protein breakdown was unchanged. Conclusion: In cachectic, critically ill burn victims, oxandrolone improves net muscle protein synthesis by increasing the efficiency of intracellular amino acid utilization.

Original languageEnglish (US)
JournalCritical Care Medicine
Volume27
Issue number12 SUPPL.
StatePublished - 1999

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Oxandrolone
Anabolic Agents
Critical Illness
Muscle Proteins
Prealbumin
Proteins
Amino Acids
Burn Units
Muscles
Skin Transplantation
Muscle Weakness
Enteral Nutrition
Nutritional Status
Phenylalanine
Isotopes
Leg
Acquired Immunodeficiency Syndrome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Hart, D. W., Wolf, S., Chinkes, D. L., Ramzy, P. I., Gore, D., & Herndon, D. (1999). Anabolic effects of oxandrolone in critically ill burn victims. Critical Care Medicine, 27(12 SUPPL.).

Anabolic effects of oxandrolone in critically ill burn victims. / Hart, David W.; Wolf, Steven; Chinkes, David L.; Ramzy, Peter I.; Gore, Dennis; Herndon, David.

In: Critical Care Medicine, Vol. 27, No. 12 SUPPL., 1999.

Research output: Contribution to journalArticle

Hart, DW, Wolf, S, Chinkes, DL, Ramzy, PI, Gore, D & Herndon, D 1999, 'Anabolic effects of oxandrolone in critically ill burn victims', Critical Care Medicine, vol. 27, no. 12 SUPPL..
Hart, David W. ; Wolf, Steven ; Chinkes, David L. ; Ramzy, Peter I. ; Gore, Dennis ; Herndon, David. / Anabolic effects of oxandrolone in critically ill burn victims. In: Critical Care Medicine. 1999 ; Vol. 27, No. 12 SUPPL.
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abstract = "Introduction: Severe burn causes a hypermetabolic, catabolic state. Loss of body protein, mainly from muscle, causes weakness, impaired immune function and delayed healing. Oxandrolone is an oral steroid that has been used in cachectic cancer and AIDS patients as well as rehabilitating burn patients to restore muscle mass. We hypothesize oxandrolone may reverse muscle catabolism in cachectic, critically ill burn patients. Methods: Ten severely burned children were enrolled in a prospective cohort analytic series. All had received care without skin grafting at outside hospitals prior to transfer to our pediatric burn unit. Upon transfer, excision and grafting and nutritional supplementation were employed. Nutritional status was assessed by weekly prealbumin measurements. Muscle protein kinetics were determined using a stable phenylalanine isotope tracer. Initial studies were done 5-7 days after admission. Six subjects were studied before and after approximately 1 week of oxandrolone 0.1 mg/kg QD. Four subjects were used as time controls and studied at matched time points. T-tests were used for statistical comparison. Data are presented as mean±SEM. Results: The four time control and six oxandrolone subjects did not differ in age or TBSA burn (7.1±3 yrs vs. 6.5±1.3 yrs; 40±5{\%} vs. 41±11{\%}). The control group arrived 34±17 days after injury, and the oxandrolone group 25±5. Prealbumin levels were low on presentation in both groups (9.3±3.8 mg/dl control vs. 7.4±2.8 oxandrolone) and remained low after one week of standard enteral feeding (14±5.3 vs. 13.3±2.2) with no differences between groups. Muscle protein net balance improved 1±6 nmol PHE/min/100cc leg in controls vs. 67±18 in the oxandrolone group (p<0.05). The improved protein metabolism in oxandrolone subjects was accompanied by an increased protein synthetic efficiency determined by the percent of intracellular amino acids directed to protein synthesis (17±6{\%} before, 37±5{\%} after oxandrolone; p=0.05). Muscle protein breakdown was unchanged. Conclusion: In cachectic, critically ill burn victims, oxandrolone improves net muscle protein synthesis by increasing the efficiency of intracellular amino acid utilization.",
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T1 - Anabolic effects of oxandrolone in critically ill burn victims

AU - Hart, David W.

AU - Wolf, Steven

AU - Chinkes, David L.

AU - Ramzy, Peter I.

AU - Gore, Dennis

AU - Herndon, David

PY - 1999

Y1 - 1999

N2 - Introduction: Severe burn causes a hypermetabolic, catabolic state. Loss of body protein, mainly from muscle, causes weakness, impaired immune function and delayed healing. Oxandrolone is an oral steroid that has been used in cachectic cancer and AIDS patients as well as rehabilitating burn patients to restore muscle mass. We hypothesize oxandrolone may reverse muscle catabolism in cachectic, critically ill burn patients. Methods: Ten severely burned children were enrolled in a prospective cohort analytic series. All had received care without skin grafting at outside hospitals prior to transfer to our pediatric burn unit. Upon transfer, excision and grafting and nutritional supplementation were employed. Nutritional status was assessed by weekly prealbumin measurements. Muscle protein kinetics were determined using a stable phenylalanine isotope tracer. Initial studies were done 5-7 days after admission. Six subjects were studied before and after approximately 1 week of oxandrolone 0.1 mg/kg QD. Four subjects were used as time controls and studied at matched time points. T-tests were used for statistical comparison. Data are presented as mean±SEM. Results: The four time control and six oxandrolone subjects did not differ in age or TBSA burn (7.1±3 yrs vs. 6.5±1.3 yrs; 40±5% vs. 41±11%). The control group arrived 34±17 days after injury, and the oxandrolone group 25±5. Prealbumin levels were low on presentation in both groups (9.3±3.8 mg/dl control vs. 7.4±2.8 oxandrolone) and remained low after one week of standard enteral feeding (14±5.3 vs. 13.3±2.2) with no differences between groups. Muscle protein net balance improved 1±6 nmol PHE/min/100cc leg in controls vs. 67±18 in the oxandrolone group (p<0.05). The improved protein metabolism in oxandrolone subjects was accompanied by an increased protein synthetic efficiency determined by the percent of intracellular amino acids directed to protein synthesis (17±6% before, 37±5% after oxandrolone; p=0.05). Muscle protein breakdown was unchanged. Conclusion: In cachectic, critically ill burn victims, oxandrolone improves net muscle protein synthesis by increasing the efficiency of intracellular amino acid utilization.

AB - Introduction: Severe burn causes a hypermetabolic, catabolic state. Loss of body protein, mainly from muscle, causes weakness, impaired immune function and delayed healing. Oxandrolone is an oral steroid that has been used in cachectic cancer and AIDS patients as well as rehabilitating burn patients to restore muscle mass. We hypothesize oxandrolone may reverse muscle catabolism in cachectic, critically ill burn patients. Methods: Ten severely burned children were enrolled in a prospective cohort analytic series. All had received care without skin grafting at outside hospitals prior to transfer to our pediatric burn unit. Upon transfer, excision and grafting and nutritional supplementation were employed. Nutritional status was assessed by weekly prealbumin measurements. Muscle protein kinetics were determined using a stable phenylalanine isotope tracer. Initial studies were done 5-7 days after admission. Six subjects were studied before and after approximately 1 week of oxandrolone 0.1 mg/kg QD. Four subjects were used as time controls and studied at matched time points. T-tests were used for statistical comparison. Data are presented as mean±SEM. Results: The four time control and six oxandrolone subjects did not differ in age or TBSA burn (7.1±3 yrs vs. 6.5±1.3 yrs; 40±5% vs. 41±11%). The control group arrived 34±17 days after injury, and the oxandrolone group 25±5. Prealbumin levels were low on presentation in both groups (9.3±3.8 mg/dl control vs. 7.4±2.8 oxandrolone) and remained low after one week of standard enteral feeding (14±5.3 vs. 13.3±2.2) with no differences between groups. Muscle protein net balance improved 1±6 nmol PHE/min/100cc leg in controls vs. 67±18 in the oxandrolone group (p<0.05). The improved protein metabolism in oxandrolone subjects was accompanied by an increased protein synthetic efficiency determined by the percent of intracellular amino acids directed to protein synthesis (17±6% before, 37±5% after oxandrolone; p=0.05). Muscle protein breakdown was unchanged. Conclusion: In cachectic, critically ill burn victims, oxandrolone improves net muscle protein synthesis by increasing the efficiency of intracellular amino acid utilization.

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