title: Growth hormone and outcome in patients with intracerebral hemorrhage: a pilot study.
abstract: BACKGROUND
  Endocrine alterations of the hypothalamic-pituitary-axis are one of the first measurable physiological changes in cerebral insults. During acute stress, human growth hormone (GH) is stimulated and has shown to have a prognostic value in various diseases. Within this pilot study, we evaluated the prognostic value of GH in patients with acute intracerebral hemorrhage (ICH).
  
  
  METHODS
  In a prospective observational study in 40 consecutive patients with ICH, GH was measured on admission. The prognostic value of GH to predict 30-day mortality and 90-day functional outcome was assessed. Favorable functional outcome was defined as Barthel Index score >85 points and Modified Rankin Scale <3 points.
  
  
  RESULTS
  GH levels were increased in patients who died within 30 days as compared to survivors (0.45 (IQR 0.20-1.51) vs. 1.51 (IQR 0.91-4.08) p = 0.03), and in patients with an unfavorable functional outcome as compared to patients with a favorable functional outcome after 90 days 0.28 (IQR 0.16-0.61) vs. 0.78 (IQR 0.31-1.99) p = 0.03). For mortality prediction, receiver-operating-characteristics revealed an area under the curve (AUC) on admission for GH of 0.78 (95% CI 0.60-0.96), which was in the range of the Glasgow Coma Score (GCS) (AUC 0.82 (95% CI 0.59-1.00) p = 0.80). For functional outcome prediction, GH had an AUC of 0.71 (95% CI 0.54-0.87), which was statistically not different from the GCS (AUC 0.81 (95% CI 0.68-0.94) p = 0.36).
  
  
  CONCLUSIONS
  In our small cohort of patients with acute ICH, elevated GH level were associated with increased mortality and worse outcome. If confirmed in a larger study, GH levels may be used as an additional prognostic factor in ICH patients. (ClincalTrials.gov number NCT00390962).
authors.affiliation: Department of Neurosurgery, University Hospital of Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Zweifel
authors.forename: Mira
authors.initials: M
authors.lastname: Katan
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.forename: Andrea
authors.initials: A
authors.lastname: Ernst
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.forename: Beat
authors.initials: B
authors.lastname: Müller
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D002543:Cerebral Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D020521:Stroke / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate; D013557:Switzerland
chemical_list: D015415:Biomarkers; D019382:Human Growth Hormone