The GH Axis in Relation to Accepting an Early Macronutrient Deficit and Outcome of Critically Ill Patients.
Journal
The Journal of clinical endocrinology and metabolism
ISSN: 1945-7197
Titre abrégé: J Clin Endocrinol Metab
Pays: United States
ID NLM: 0375362
Informations de publication
Date de publication:
01 11 2019
01 11 2019
Historique:
received:
09
04
2019
accepted:
24
07
2019
pubmed:
31
7
2019
medline:
4
6
2020
entrez:
31
7
2019
Statut:
ppublish
Résumé
Changes in the GH axis during critical illness resemble fasting in healthy adults and contribute to hypercatabolism, which potentially affects outcome. Accepting macronutrient deficits by withholding parenteral nutrition (PN) during the first week in the intensive care unit (ICU; late PN) reduced complications and accelerated recovery as compared with early use of PN (early PN). To investigate how late PN affects the GH axis in relation to its clinical outcome benefits. Preplanned subanalysis of the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients randomized controlled trial. A total of 1128 patients for time-course study, 20 patients investigated for nocturnal GH pulsatility, and 600 patients investigated for muscle weakness, with early PN and late PN patients having comparable baseline characteristics. Withholding PN during the first ICU week (late PN) vs early PN. Changes in serum GH, IGF-I, IGF-binding protein (IGFBP) 3, and IGFBP1 concentrations from ICU admission to day 4 or last ICU day for patients with a shorter ICU stay (d4/LD) and association in multivariable analyses with likelihood of earlier live ICU discharge, risk of new infection, and muscle weakness. Late PN attenuated a rise in serum GH and IGF-I (P < 0.0001), did not affect IGFBP3, and attenuated a decrease in IGFBP1 concentrations from admission to d4/LD (P < 0.0001) as compared with early PN. Late PN decreased nonpulsatile (P = 0.005), but not pulsatile, GH secretion. Adjusting the multivariable models for the observed GH axis alterations increased the independent benefit of late PN for all outcomes. GH axis alterations induced by late PN were independently associated with adverse outcomes (P ≤ 0.03). Accepting macronutrient deficits early during critical illness further suppressed the GH axis, which statistically attenuated its clinical outcome benefits.
Identifiants
pubmed: 31361307
pii: 5540440
doi: 10.1210/jc.2019-00842
doi:
Substances chimiques
IGFBP1 protein, human
0
IGFBP3 protein, human
0
Insulin-Like Growth Factor Binding Protein 1
0
Insulin-Like Growth Factor Binding Protein 3
0
Human Growth Hormone
12629-01-5
Insulin-Like Growth Factor I
67763-96-6
Banques de données
ClinicalTrials.gov
['NCT00512122']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
5507-5518Informations de copyright
Copyright © 2019 Endocrine Society.