title: Insulin-like Growth Factor I and its binding protein 3 in sepsis.
abstract: OBJECTIVE
  To investigate the Growth Hormone (GH)/Insulin-like Growth Factor-I (IGF-I) axis and identify the factors that determine IGF-I levels in adult septic patients of variable severity, i.e., with sepsis, severe sepsis or septic shock, in the acute phase of disease.
  
  
  METHODS
  In 107 consecutive septic patients (44 with sepsis, 13 with severe sepsis, and 50 with septic shock), GH, IGF-I, Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), insulin, cortisol, albumin, thyroid hormones, C-reactive protein and interleukin-6 serum levels were measured once within 48 h after onset of a septic episode. Twenty-nine healthy volunteers served as controls.
  
  
  RESULTS
  IGF-I and IGFBP-3 levels were decreased in patients with sepsis and severe sepsis (versus controls), decreasing further in patients with septic shock (versus sepsis). IGF-I levels were positively related to IGFBP-3, albumin, triiodothyronine and thyroxine, and inversely related to cortisol, sepsis severity, C-reactive protein, interleukin-6 and age. In multiple regression analysis, IGF-I levels were independently related to IGFBP-3 and albumin (lower in patients with decreased IGFBP-3 and albumin levels) (p<0.001 and p=0.01, respectively), and cortisol (lower in patients with increased cortisol levels) (p=0.04). IGFBP-3 accounted for most of the variance explained by the model (R(2)=0.519). GH levels were not related to IGF-I levels or mortality. IGF-I and IGFBP-3 levels were not associated with mortality.
  
  
  CONCLUSIONS
  The GH/IGF-I axis is severely disrupted in septic patients. IGFBP-3 is the major determinant of IGF-I levels.
authors.affiliation: First Department of Critical Care Medicine and Pulmonary Services, Medical School of Athens University, Evaggelismos Hospital, Athens, Greece.
authors.forename: Chrysoula
authors.initials: C
authors.lastname: Papastathi
authors.forename: Antonis
authors.initials: A
authors.lastname: Mavrommatis
authors.forename: Spyros
authors.initials: S
authors.lastname: Mentzelopoulos
authors.forename: Evangellia
authors.initials: E
authors.lastname: Konstandelou
authors.forename: Maria
authors.initials: M
authors.lastname: Alevizaki
authors.forename: Spyros
authors.initials: S
authors.lastname: Zakynthinos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000401:mortality* / Q000473:pathology; D013974:Thyroxine / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007328:Insulin; D018972:Insulin-Like Growth Factor Binding Protein 3; D015850:Interleukin-6; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein; D013974:Thyroxine; D006854:Hydrocortisone