Serum Insulinlike Growth Factor-1 and Its Binding Protein-3 Levels in Children With Cirrhosis Waiting for a Liver Transplant

Objectives: Investigate the prognostic value of serum insulinlike growth factor-1 (IGF-1) and its binding protein 3 (IGFBP-3) in pediatric patients with liver cirrhosis, and investigate the correlation between these parameters and other available prognostic factors including Child-Pugh scoring, Pediatric End-stage Liver Disease, and Mayo End-stage Liver Disease scoring. Materials and Methods: This prospective, case-controlled study was done at the Nemazee hospital for 12 months from August 2009 to August 2010. It included 45 pediatric patients (< 18 years) diagnosed with liver cirrhosis and 38 healthy age- and sex-matched controls. The extent and severity of the liver disease was evaluated by the Child-Pugh classification and Pediatric End-stage Liver Disease / Mayo End-stage Liver Disease scores. Serum levels of IGF-1 and IGFBP-3 were determined and were compared to controls and their correlation with Child-Pugh and Pediatric End-stage Liver Disease / Mayo End-stage Liver Disease scores were investigated. Results: The most-common cause of liver cirrhosis was biliary atresia being found in 11 patients (24.4%) followed by tyrosinemia in 8 (17.8%). IGF-1 serum levels were significantly lower in cirrhotic patients compared with controls (3.85 +/- 3.69 nmol/L vs 41.79 +/- 16.03 nmol/L; P < .001). Serum levels of IGFBP-3 also were significantly lower in patients with liver cirrhosis compared with healthy controls (46.66 +/- 30.57 nmol/L vs 205.63 +/- 25.52 nmol/L; P < .001). Serum levels of IGF-1 were significantly lower in patients with stage B (P = .047) and C (P = .036) of Child-Pugh classification compared with stage A. Serum levels of IGF-1 (r approximate to 0.227; P = .034) and IGFBP-3 (r approximate to 0.389; P = .008) were negatively correlated with Pediatric End-stage Liver Disease / Mayo End-stage Liver Disease scores. Conclusions: The serum levels of IGF-1 and IGFBP-3 are decreased in children with liver cirrhosis. The stage of liver dysfunction is correlated to serum levels of IGF-1 and IGFBP-3 in children. Thus, these 2 factors can be used for assessing the prognosis and outcome in those children with liver cirrhosis.