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 of growth hormone (GH) - stimulated insulin-like growth factor-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] and decompensated 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 measured before and 24 hr after a single subcutaneous injection of recombinant human GH (rhGH, 0.14 units/kg). Patients (mean age 56 years) were followed prospectively for three 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 rhGH injection (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 poor prognosis, with 15% survival at one year, whereas levels >10 nmol/liter had a 100% survival rate at one and two 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-3 serum levels at baseline (1.7 ± 0.3 vs 0.86 ± 0.2 mg/liter) and at 24 hr (2.04 ± 0.38 vs 0.99 ± 0.3 mg/liter) did not add to the predictive value of stimulated IGF-I levels at 24 hr and were less accurate in predicting the outcome in comparison to CP score (80%). We conclude that stimulated IGF-1 <10 nmol/liter may be a true predictor of a negative prognosis in patients with liver cirrhosis.