title: The role of insulin-like growth factor I, growth hormone, and plasma proteins in surgical outcome of children with congenital heart disease.
abstract: OBJECTIVE: To evaluate postoperative serum concentrations of growth hormone (GH), insulin-like growth factor I (IGF-I), C-reactive protein (CRP), and prealbumin as predictors of clinical outcome as defined by the incidence of 30-day postoperative mortality, the postoperative length of pediatric intensive care unit (PICU) stay, and the risk of postoperative infection in infants of high surgical risk undergoing operative correction of congenital cardiac defects. DESIGN: Prospective, observational study. SETTING: PICU of a university hospital. PATIENTS: A high surgical risk group of 36 children admitted for elective cardiac surgery. INTERVENTION: Measures of serum levels of IGF-I, basal GH, prealbumin, and CRP. These parameters were followed from the hospital admission until the discharge from the PICU at specific time points: preoperative and on the second, fifth, and tenth postoperative days. MEASUREMENTS AND MAIN RESULTS: Surgical stress response was marked by an increase of GH and CRP levels and a fall in prealbumin levels on the second postoperative day. Prealbumin, CRP, and GH returned to preoperative levels on average 10 days following surgery; the values of IGF-I, which had decreased on the fifth day, remained below those values observed before the surgery. Patients whose PICU stay was </= 10 days showed significant decreases in GH and CRP serum levels and an increase in IGF-I and prealbumin levels on postoperative day 5 compared with the patients who stayed > 10 days. The sustained high CRP (>/= 8.4 mg/dL, p <.05) and GH (>/= 66 mIU/L, p <.03) values on the fifth day were associated with increased mortality in contrast with patients in whom the values were returning to preoperative levels. CONCLUSIONS: Serial monitoring of serum GH, IGF-I, CRP, and prealbumin levels may be useful as a means to a) stratify the acute metabolic response to surgically induced injury insult and b) predict clinical outcome as defined by the length of stay in the PICU and the likelihood of 30-day survival following open-heart surgery in infants.
authors.affiliation: Pediatric Intensive Care Unit (Drs. Leite and Carvalho) and the Section of Adolescence Medicine (Dr. Fisberg), Department of Pediatrics, and the Discipline of Endocrinology (Dr. Vieira), Department of Medicine, São Paulo Federal University-Brazil, São Paulo, Brazil, and the Department of Surgery (Dr. Chwals), Chicago Children's Hospitial, University of Chicago, Chicago, IL.
authors.forename: Heitor
authors.initials: H
authors.lastname: Pons Leite
authors.forename: José
authors.initials: J
authors.lastname: Gilberto Henriques Vieira
authors.forename: Werther
authors.initials: W
authors.lastname: Brunow De Carvalho
authors.forename: Walter J.
authors.initials: WJ
authors.lastname: Chwals