Insulin like growth factor-I in acute subarachnoid hemorrhage: a prospective cohort study.
BACKGROUND
Neuroendocrine deficiencies may affect recovery after aneurysmal subarachnoid hemorrhage (aSAH). Insulin like growth factor-I (IGF-I) regulates neuronal growth and apoptosis in ischemic stroke. Our study was designed to a) characterize the behavior of serum IGF-I and growth hormone (GH) in the acute and late phases after aSAH reflecting possible pituitary gland function and b) evaluate the association between IGF-I and morbidity assessed by Glasgow outcome scale (GOS) and health related quality of life (HRQoL) in patients with aSAH.


METHODS
In this prospective cohort study, patients with aSAH (n = 30) were compared to patients who underwent elective aneurysm surgery (n = 16). Serum GH and IGF-I concentrations were measured daily for five (controls) or seven (aSAH) days and at three months. GOS and 15d HRQoL was measured at three months. A mixed models method was used for testing between the groups. For factors possibly affecting HRQoL in aSAH patients, we constructed a Bayesian predicting model using a P-course Bayesian classifier.


RESULTS
The mean IGF-I concentrations for days one to five were 8.1 +/- 3.5 nmol/l in patients with aSAH and 11.2 +/- 3.1 in the control group (P = 0.01). No corresponding difference was found at three months. Serum GH concentrations were similar in both patient groups. Severity of the aSAH did not affect serum IGF-I concentrations. Patients with GOS <or= 4 had lower IGF-I concentrations and lower HRQoL than patients with GOS 5 (P = 0.02 and 0.003 respectively). The 15d HRQoL was 0.81 +/- 0.16 in patients with aSAH and 0.86 +/- 0.09 in control patients (P = 0.24). In the Bayesian model, the use of statins prior to aSAH, hyponatremia, high maximal sequential organ specific score (SOFAmax), and low cumulative IGF-I concentrations on days one to seven were associated with poor HRQoL (accuracy 89%, sensitivity 86%, and specificity 93%).


CONCLUSIONS
IGF-I concentrations are low during acute aSAH, which may have an impact on morbidity.


BACKGROUND
ClinicalTrials.gov Identifier NCT00614887.
Bendel
Stepani
S
Department of Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland. Stepani.Bendel@kuh.fi
Koivisto
Timo
T
Ryynänen
Olli-Pekka
OP
Ruokonen
Esko
E
Romppanen
Jarkko
J
Kiviniemi
Vesa
V
Uusaro
Ari
A
D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood*; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult
D018970:Insulin-Like Growth Factor Binding Protein 1; D019382:Human Growth Hormone