Growth Hormone Treatment on Nutrition Post-ABI

Author/Year/ Country/Study design/PEDro Score/N

 

Methods

 

Outcomes

Devesa et al. (2013)
Spain
Case Series

Population: TBI; Mean Age=26.7yr; Gender: Male=8, Female=5; Time Post Injury=2.5mo-11yr.
Intervention: TBI patients who were with and without acquired growth hormone deficiency (GHD) all received the same growth hormone treatment protocol, as well as clinical rehabilitation as necessary per individual.
Outcome Measures: Plasma insulin-like growth factor 1 (IGF-1), cognitive and motor improvements.

  1. Plasma IGF-1 values increased after GH treatment in GHD and non-GHD patients (p<0.01, p<0.05, respectively).
  2. The increase in plasma IGF-1 values was significantly higher in GHD than non-GHD patients (p<0.01).
  3. In general, cognitive improvements were better than motor improvements. 

Hatton et al. (2006)
USA
PEDro=7
N=97

Population: TBI; Treatment Group: Mean Age=30yr; Gender: Male=38, Female=11; Mean GCS Score=6.4. Control Group: Mean Age=29yr; Gender: Male=33, Female=15; Mean GCS Score=6.7.
Treatment: Patients were randomized to receive either IGF-I/GH or placebo within 72 hr of admission to the hospital. Those in the treatment group received 0.01mg/kg/hr IV IGF-I by continuous infusion for up to 14 d, as well as 0.05mg/kg/d subcutaneous GH.  Controls were given normal saline but insulin was used to keep glucose concentrations <200mg/dl. Patients also received concomitant nutritional support (enteral or parenteral).
Outcome Measure: Glucose concentrations, energy expenditure, nitrogen balance, protein and calorie intake.

  1. Nutritional endpoints: energy expenditure was slightly different for the two groups (2271±575.6 kcal/d in the control group and 2366±627.8 kcal/d in the treatment group).
  2. In the treatment group, the mean daily glucose concentrations were higher than those of the control group (123±24 mg/dl vs. 104±11mg/dl; p<0.03). 
  3. Within the first 24 hr nitrogen balance was positive and it remained positive for the duration of the study.
  4. Nitrogen balance was higher for the IGHI/GH group (p=0.0001). Neither group reached calorie or protein intake goals; groups did not differ significantly in their intake.

Behrman et al. (1995)
USA
RCT
PEDro=4
N=16

 

Population: Head injury=11, SCI=5; Gender: Male=12, Female=4; Mean GCS score=10. Intervention Group (n=8): Mean Age=23yr. Control Group (n=8): Mean Age=46yr.
Treatment: Patients were randomly allocated to receive either intramuscular growth hormone (GH; 0.2mg/kg) every day or 1mL normal saline (control) for 7-10d. Assessments were made on days 1, 3, 7, and 10.
Outcome Measure: Nitrogen balance, glucose concentration, triglyceride concentrations, thyroid function, serum protein concentration, lymphocyte count, prognostic nutritional index (PNI).

  1. GH treatment did not improve nitrogen balance, glucose concentration, triglyceride concentrations or thyroid function.
  2. GH significantly enhanced constitutive serum protein concentrations (trasnsferrin: p<0.05, albumin: p<0.05).
  3. Total lymphocyte count was significantly higher in the GH group than in the control group (p<0.05) by day 10.
  4. PNI was significantly improved in the GH group compared to the control group (p<0.05) by day 10.

PEDro = Physiotherapy Evidence Database rating scale score (Moseley et al., 2002).