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January 1994

Effect of Recombinant Human Insulin-like Growth Factor I and Early Total Parenteral Nutrition on Immune Depression Following Severe Head Injury

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).

Arch Surg. 1994;129(1):66-71. doi:10.1001/archsurg.1994.01420250078010

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)