Prognostic Value of Generation of Growth Hormone-Stimulated Insulin-Like Growth Factor-I (IGF-I) and Its Binding Protein-3 in Patients with Compensated and Decompensated Liver Cirrhosis

Our aim was to study the prognostic value ofgrowth hormone (GH)-stimulated insulin-like growthfactor-I (IGF-I) and IGF-binding protein-3 (IGFBP-3)generation in patients with compensated [group 1 (N = 8) with a Child-Pugh (CP) score of 5-8] anddecompensated postnecrotic liver cirrhosis [group 2 (N= 7) with a CP score of 9-12]. Serum levels of IGF-I,GH-binding protein (GHBP), and IGFBP-3 were measuredbefore and 24 hr after a single subcutaneous injectionof recombinant human GH (rhGH, 0.14 units/kg). Patients(mean age 56 years) were followed prospectively forthree years. Six patients (40%) died during the follow-up period, of whom half had a CP score<9. Mean serum IGF-I levels 24 hr after rhGHinjection (group 1 vs group 2, 17.4 ± 6.8 vs 7.4± 0.7 nmol/liter) predicted survival with 93%accuracy. Levels <10 nmol/liter portended a poorprognosis, with 15% survival at one year, whereas levels>10 nmol/liter had a 100% survival rate at one andtwo years, respectively. Baseline IGF-I (9.98 ± 2.0 vs 6.38 ± 0.8 nmol/liter), GHBP (9.2± 3 vs 5.7 ± 0.8%/50 μl), and IGFBP-3serum levels at baseline (1.7 ± 0.3 vs 0.86± 0.2 mg/liter) and at 24 hr (2.04 ± 0.38vs 0.99 ± 0.3 mg/liter) did not add to the predictive value ofstimulated IGF-I levels at 24 hr and were less accuratein predicting the outcome in comparison to CP score(80%). We conclude that stimulated IGF-1 < 10nmol/liter may be a true predictor of a negative prognosisin patients with liver cirrhosis.