Growth hormone-stimulated IGF-1 generation in cirrhosis reflects hepatocellular dysfunction.
OBJECTIVE
Previous studies reported decreased serum IGF-1 levels in cirrhosis. We aimed to correlate GH-stimulated IGF-1 responses with both MELD and Child-Pugh scores and determine the impact of portal hypertension and nutrition on IGF-1 responses.


METHODS
Fifty-three patients (56+/-2 yrs) with cirrhosis were enrolled. Serum IGF-1 levels were measured by RIA before and 24h after a single injection of GH (0.06 mg/kg).


RESULTS
Compared to controls, basal IGF-1 levels were significantly decreased in patients with cirrhosis (17.3+/-6.3 vs 13.6+/-5.1, P<0.001). Increments in IGF-1 levels were significantly lower in cirrhotic patients (controls: 133% vs 49% in MELD score <10, 38% in MELD score 11-18, and 13% in MELD score 19-24, p<0.001). 37% of patients had blunted IGF-1 responses. Increments in IGF-1 levels correlated with albumin (r=0.6), portal congestive index (r=0.4), and MAMC (r=0.25). By multivariate analysis, only CP (OR 5.7) and MELD scores (OR 4.5) accurately differentiated between blunted or non-blunted IGF-1 responses and not portal hypertension (OR 0.9) or malnutrition (OR 1.35).


CONCLUSIONS
Cirrhosis is associated with low IGF-1 levels and an attenuated response to exogenous GH. These findings correlate better with the extent of hepatic dysfunction rather than the presence of portal hypertension or malnutrition.
Assy
Nimer
N
Liver Unit, Ziv Medical Center, Safed 13100, Israel. assy.n@ziv.health.gov.il
Pruzansky
Yosef
Y
Gaitini
Diana
D
Shen Orr
Zila
Z
Hochberg
Ze'ev
Z
Baruch
Yaacov
Y
D000328:Adult; D000368:Aged; D001201:Ascites / Q000378:metabolism / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D019382:Human Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D006975:Hypertension, Portal / Q000378:metabolism / Q000503:physiopathology; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology*; D008111:Liver Function Tests / Q000379:methods* / Q000592:standards; D008297:Male; D044342:Malnutrition / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018616:Ultrasonography, Doppler, Duplex
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I