| Objective:The objective of this study was to explore the change trend and clinical value of growth hormone,GH and insulin-like growth factor 1,IGF-1 in patients with severe trauma admitted into the intensive care unit.Methods:The type of this study is a observational study.And this study was conducted in a comprehensive hospital.The subjects of this study were trauma patients who were admitted into intensive care unit(ICU).The inclusion criteria were:(1)Older than 18 years;(2)The patients were admitted into the ICU after trauma within 24 hours;(3)and injury severity score(ISS)? 16;(4)Length of stay in the ICU longer than 3 days.The exclusion criteria:(1)Suspected diseases which could change the level of GH or IGF-1,including pituitary tumor,diabetes,partial liver diseases,renal dysfunction,pancreatic cancer,anterior pituitary dysfunction,cirrhosis,and brain tumor near the pituitary and so on;(2)The various comorbidities,including hematological,respiratory or cardiological and renal diseases.Collect the data on level of GH,IGF-1,IGFBP-3,pre-albumin,albumin,total albumin,and cholinesterase.etc.at the first day,the third day and the seventh day after ICU admission.Along with collected the data on demographic information(sex,age),injury severity(injury mechanism,diagnosis,injury severity score,ISS,Acute Physiology,Age,and Chronic Health Evaluation system ?,APECHE ?,glasgow coma score,GCS),prognostic indicators(hospital mortality,ICU length of stay,hospital length of stay and duration of mechanical ventilation).The patients were grouped into survival group and death group,then the above indicators were compared between these two groups.The multiple Logistic regression analysis was used to assess whether the level of GH and IGF-1 were the independent risk factors for hospital mortality.The receiver operating characteristic curve,ROC was used to evaluate the predictive ability of GH or IGF-1 on hospital mortality.Results:1.A total of 75 severe trauma patients were included from May 2015 to April 2016.The mean age of included participants 54±16 years,and among these subjects,73.3%were male.The range of ISS was 16?57,and the mean value was 28±10 and according APACHE ? were 7?27,and 21±10 respectively.The median GCS was 10(interquartile range,IQR 5?15).The hospital mortality was 18.7%.2.All included patients,the GH levels had an increasing tendency from the ICU admission to the seven day after ICU admission,and the value were 0.57(0.23?0.90)?g/L,0.69(0.38?1.69)?g/L,1.02(0.50?2.11)?g/L,however,it did not reach statistical significance.The IGF-1 and IGFBP-3 levels also had an increasing tendency,and the value were 83.00(65.00?136.00)ng/mL,94.70(70.50?131.00)ng/mL,128.00(93.00?203.00)ng/mL;2.10(1.80?2.70)?g/mL?2.36(2.10?3.10)?g/mL,2.70(2.10?3.20)?gg/mL,and there were statistical significance.3.As for the association between ISS score and these indicators,only the third day IGFBP-3 was inversely associated with the ISS score,and the correlation coefficient was-0.35(P<0.05).As for the association between APACHE II score and these indicators,Only the third day IGFBP-3,IGF-1 were inversely associated with the APACHE II score,and the correlation coefficient were-0.32,-0.36(P<0.05).4.The levels of GH of patients in the non-survival group were significantly higher than those in the survival group at the first day,the third day and the seventh day after ICU admission,and the values were 1.83(1.21?2.50)?g/L,0.63(0.38?1.15)?g/L,(P<0.05);2.59(0.74?3.92)?g/L,0.69(0.31?1.64)?g/L(P<0.05);3.28(2.90?3.65)?g/L,0.85(0.50-1.72)?g/L(P<0.05).And the level of GH in non-survival group was increasing gradually.The levels of IGF-1 of patients between two groups did not achieve statistic difference at the first day,the third day and the seventh day after ICU admission,and the values were 74.00(50.50?136.75)ng/mL,97.50(72.55?157.00)ng/mL,(P=0.08);76.95(72.50?106.75)ng/mL,100.00(71.05?151.75)ng/mL(P=0.16);133.30(63.60?203.00)ng/mL,128.00(93.50?197.00)ng/mL(P=0.76).The levels of IGFBP-3 of patients between two groups did not achieve statistic difference at the first day,the third day and the seventh day after ICU admission,and the values were 2.0(1.32?2.60)?g/mL,2.40(1.90?3.07)?g/mL,(P=0.54);2.20(1.60?2.38)?g/mL,2.33(2.10?2.85)?g/mL(P=0.06);2.13(1.55?2.70)?g/mL,2.70(2.15?3.20)?g/mL(P=0.40).5 The albumin,total albumin,IGFBP-3,GH level at the first day,ISS score,APACHE ? score,and GCS score were significantly different between the survival and death group.The results of the Logistic regression analysis indicated that GH level at the first day,ISS score,APACHE ? score,and GCS score were the independent risk factor of hospital mortality ORs and 95%CI were(3.946,1.069?14.564),(1,154,1.029?1.294),(1.243,1.011?1.527),(0.666,0.476?0.933)separately.The levels of GH?IGF-1 and IGFBP-3 at both the first day,and the third,seventh day were not associated with the length of ICU stay,length of hospital stay and the duration of mechanical ventilation.6.The AUCs of GH_day1,GH/IGF-1,GCS,APACHE??ISS in predicting the hospital mortality were 0.772(95%CI,0.640?0.904),0.800(95%CI,0.663?0.937),0.833(95%CI,0.736?0.930),0.859(95%CI,0.767?0.952),0.862(95%CI,0.768?0.955)respectively.Conclusions:The level of serum growth hormone in patients with severe trauma increased after a week of severe trauma,which was not directly related to the severity of the disease,but the high values were positively correlated with the increased risk of hospitalization. |
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