Effect of recombinant human insulin-like growth factor I and early total parenteral nutrition on immune depression following severe head injury.
OBJECTIVE
To determine the effects of insulin-like growth factor I (IGF-I) and aggressive nutrition on CD4/CD8 ratios following head injury.


METHODS
Randomized controlled trial.


METHODS
An urban level 1 trauma center.


METHODS
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.


METHODS
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.


METHODS
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.
Kudsk
K A
KA
Department of Surgery, University of Tennessee, Memphis.
Mowatt-Larssen
C
C
Bukar
J
J
Fabian
T
T
Oellerich
S
S
Dent
D L
DL
Brown
R
R
D000328:Adult; D016516:CD4-CD8 Ratio; D006259:Craniocerebral Trauma / Q000097:blood / Q000276:immunology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000276:immunology / Q000627:therapeutic use*; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D010289:Parenteral Nutrition, Total; D011994:Recombinant Proteins / Q000276:immunology / Q000627:therapeutic use
D011994:Recombinant Proteins; D007334:Insulin-Like Growth Factor I