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Nutritional parameters in patients with severe catabolism due to trauma or sepsis

Our previous studies indicate that in critically ill patients ICF-I levels are reduced to a greater extent in septic (S) than in trauma (T) subjects. However, it is well known that IGF-I levels depend on nutrition as well as on somatotrope secretion. Aim of the present study was to verify the levels of IGF-I and other nutritional parameters such as albumin (A), prealbumin (PRE-A), transferrin (TRA) and retinol-binding-globulin (RBG) in septic patients [n = 11, age (mean ± SEM) 56.1 ± 2.7 years, BMI 25.2 ± 0.9 kg/m2] and in trauma patients (n = 13, age 42.4 ± 4.1 years, BMI 25.0 ± 0.8 kg/m2) after ICU admission. Both groups were characterized by similar scores of catabolism (SAPSII and MOF score) and underwent similar artificial nutrition. Nutritional parameters were evaluated on day 1, 3, 5 and 7 after ICU admission. Both in S and in T, IGF-I, A, PRE-A, TRA and RBG levels on day 1 of ICU admission were lower than the normal range. Basal IGF-I levels in S were lower than those in T (82.9 ± 13.0 versus 127.0 ± 16.4 μg/1, P < 0.05). IGF-I levels increased on day 7 to a lower (P < 0.05) extent in S (110.3 ± 9.5, P < 0.05 versus day 1) than in T (211.4 ± 25.5, P < 0.01 versus day 1). Basal A and RBG levels in S (3.0 ± 0.2 g/dl and 2.8 ± 0.9 mg/dl) were similar to those in T (3.2 ± 0.1 g/dl and 3.1 ± 0.3 mg/dl); in both groups A levels did not show variations up to day 7 while RBG showed a trend toward increase (P < 0.05 in S). Basal PRE-A and TRA levels in S (10.9 ± 2.5 mg/dl and 108.8 ± 10.7 mg/dl) were lower (P < 0.01) than those in T (17.8 ± 1.4 mg/dl and 168.7 ± 8.3 mg/dl). PRE-A and TRA levels did not show significant variations up to day 7 persisting lower (P < 0.05) in S than in T.

In conclusion, our results further demonstrate that, in spite of similar score of catabolism, in critically ill patients the reduction of IGF-I, PRE-A and TRA levels is more marked in septic than in trauma patients. These findings indicate that the influence of nutrition and/or somatotrope function on ICF-I synthesis and release varies among different catabolic states.

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Gallioli, G., Pittoni, G., Zanello, M. et al. Nutritional parameters in patients with severe catabolism due to trauma or sepsis. Crit Care 1 (Suppl 1), P100 (1997).

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