Recombinant human growth hormone treatment in pediatric burn patients and its role during the hepatic acute phase response

Marc G. Jeschke, Robert E. Barrow, David Herndon

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Objective: Recombinant human growth hormone (rHGH) has been shown to increase mortality in adult trauma patients; however, little has been reported on its side effects in children. The acute phase response has been suggested to be a contributing factor to trauma mortality. Therefore, the purpose of this study was to examine the effects of exogenous rHGH on the acute phase response in pediatric burn patients. Design: Prospective, randomized, double-blind study. Setting: Shriners Hospital for Children. Patients: Thermally injured pediatric patients, ranging in age from 0.1 to 16 yrs. Interventions: Twenty-eight thermally injured children received either 0.2 mg/kg/day of rHGH or saline (placebo) within 3 days of admission and for at least 25 days. Measurements and Main Results: Measurements were patient demographics, incidence of sepsis, inhalation injury, mortality, serum constitutive proteins, acute phase proteins, proinflammatory cytokines and insulin-like growth factor-I (ISF-I), insulin-like growth factor binding protein (IGFBP)-1, and IGFBP-3. No differences could be demonstrated in age, gender, burn size, incidence in sepsis (20% vs. 26%), inhalation injury (46% vs. 27%), or mortality (8% vs. 7%) between those receiving rHGH or placebo. Serum IGF-I and IGFBP-3 increased with rHGH treatment, whereas serum IGFBP-1 decreased compared with placebo (p < .05). Burned children treated with rHGH required significantly less albumin substitution to maintain normal levels compared with placebo (p < .05). Those receiving rHGH demonstrated a decrease in serum C-reactive protein and serum amyloid-A and an increase in serum retinol-binding protein compared with placebo (p < .05). rHGH decreased serum tumor necrosis factor-α and interleukin (IL)-1β, whereas no changes were found for serum IL-1α, IL-6, and IL-10 compared with placebo (p < .05). Free fatty acids were elevated in burned children who received rHGH (p < .05). Conclusion: Data indicate that rHGH does not increase mortality. rHGH decreased acute phase proteins, tumor necrosis factor-α and IL-1β, which is associated with increases in constitutive hepatic proteins and IGF-I.

Original languageEnglish (US)
Pages (from-to)1578-1584
Number of pages7
JournalCritical Care Medicine
Volume28
Issue number5
StatePublished - 2000

Fingerprint

Acute-Phase Reaction
Human Growth Hormone
Growth Hormone
Pediatrics
Liver
Placebos
Insulin-Like Growth Factor I
Interleukin-1
Mortality
Therapeutics
Insulin-Like Growth Factor Binding Protein 1
Serum
Insulin-Like Growth Factor Binding Protein 3
Acute-Phase Proteins
Wounds and Injuries
Inhalation
Blood Proteins
Sepsis
Tumor Necrosis Factor-alpha
Serum Amyloid A Protein

Keywords

  • Acute phase proteins
  • Acute phase response
  • Burns
  • Constitutive hepatic proteins
  • Cytokines
  • Recombinant human growth hormone
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Recombinant human growth hormone treatment in pediatric burn patients and its role during the hepatic acute phase response. / Jeschke, Marc G.; Barrow, Robert E.; Herndon, David.

In: Critical Care Medicine, Vol. 28, No. 5, 2000, p. 1578-1584.

Research output: Contribution to journalArticle

Jeschke, Marc G. ; Barrow, Robert E. ; Herndon, David. / Recombinant human growth hormone treatment in pediatric burn patients and its role during the hepatic acute phase response. In: Critical Care Medicine. 2000 ; Vol. 28, No. 5. pp. 1578-1584.
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N2 - Objective: Recombinant human growth hormone (rHGH) has been shown to increase mortality in adult trauma patients; however, little has been reported on its side effects in children. The acute phase response has been suggested to be a contributing factor to trauma mortality. Therefore, the purpose of this study was to examine the effects of exogenous rHGH on the acute phase response in pediatric burn patients. Design: Prospective, randomized, double-blind study. Setting: Shriners Hospital for Children. Patients: Thermally injured pediatric patients, ranging in age from 0.1 to 16 yrs. Interventions: Twenty-eight thermally injured children received either 0.2 mg/kg/day of rHGH or saline (placebo) within 3 days of admission and for at least 25 days. Measurements and Main Results: Measurements were patient demographics, incidence of sepsis, inhalation injury, mortality, serum constitutive proteins, acute phase proteins, proinflammatory cytokines and insulin-like growth factor-I (ISF-I), insulin-like growth factor binding protein (IGFBP)-1, and IGFBP-3. No differences could be demonstrated in age, gender, burn size, incidence in sepsis (20% vs. 26%), inhalation injury (46% vs. 27%), or mortality (8% vs. 7%) between those receiving rHGH or placebo. Serum IGF-I and IGFBP-3 increased with rHGH treatment, whereas serum IGFBP-1 decreased compared with placebo (p < .05). Burned children treated with rHGH required significantly less albumin substitution to maintain normal levels compared with placebo (p < .05). Those receiving rHGH demonstrated a decrease in serum C-reactive protein and serum amyloid-A and an increase in serum retinol-binding protein compared with placebo (p < .05). rHGH decreased serum tumor necrosis factor-α and interleukin (IL)-1β, whereas no changes were found for serum IL-1α, IL-6, and IL-10 compared with placebo (p < .05). Free fatty acids were elevated in burned children who received rHGH (p < .05). Conclusion: Data indicate that rHGH does not increase mortality. rHGH decreased acute phase proteins, tumor necrosis factor-α and IL-1β, which is associated with increases in constitutive hepatic proteins and IGF-I.

AB - Objective: Recombinant human growth hormone (rHGH) has been shown to increase mortality in adult trauma patients; however, little has been reported on its side effects in children. The acute phase response has been suggested to be a contributing factor to trauma mortality. Therefore, the purpose of this study was to examine the effects of exogenous rHGH on the acute phase response in pediatric burn patients. Design: Prospective, randomized, double-blind study. Setting: Shriners Hospital for Children. Patients: Thermally injured pediatric patients, ranging in age from 0.1 to 16 yrs. Interventions: Twenty-eight thermally injured children received either 0.2 mg/kg/day of rHGH or saline (placebo) within 3 days of admission and for at least 25 days. Measurements and Main Results: Measurements were patient demographics, incidence of sepsis, inhalation injury, mortality, serum constitutive proteins, acute phase proteins, proinflammatory cytokines and insulin-like growth factor-I (ISF-I), insulin-like growth factor binding protein (IGFBP)-1, and IGFBP-3. No differences could be demonstrated in age, gender, burn size, incidence in sepsis (20% vs. 26%), inhalation injury (46% vs. 27%), or mortality (8% vs. 7%) between those receiving rHGH or placebo. Serum IGF-I and IGFBP-3 increased with rHGH treatment, whereas serum IGFBP-1 decreased compared with placebo (p < .05). Burned children treated with rHGH required significantly less albumin substitution to maintain normal levels compared with placebo (p < .05). Those receiving rHGH demonstrated a decrease in serum C-reactive protein and serum amyloid-A and an increase in serum retinol-binding protein compared with placebo (p < .05). rHGH decreased serum tumor necrosis factor-α and interleukin (IL)-1β, whereas no changes were found for serum IL-1α, IL-6, and IL-10 compared with placebo (p < .05). Free fatty acids were elevated in burned children who received rHGH (p < .05). Conclusion: Data indicate that rHGH does not increase mortality. rHGH decreased acute phase proteins, tumor necrosis factor-α and IL-1β, which is associated with increases in constitutive hepatic proteins and IGF-I.

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