Growth hormone-stimulated IGF-1 generation in cirrhosis reflects hepatocellular dysfunction

Background/Aims: Previous studies reported decreased serum IGF-1 levels in cirrhosis. We aimed to correlate GH-stimulated IGF-1 responses with both MELD and Child-Pugh scores and determine the impact of portal hypertension and nutrition on IGF-1 responses. Methods: Fifty-three patients (56 +/- 2 yrs) with cirrhosis were enrolled. Serum IGF-1 levels were measured by RIA before and 24 h after a single injection of GH (0.06 mg/kg). Results: Compared to controls, basal IGF-1 levels were significantly decreased in patients with cirrhosis (17.3 +/- 6.3 vs 13.6 +/- 5.1, P < 0.001). Increments in IGF-1 levels were significantly lower in cirrhotic patients (controls: 133% vs 49% in MELD score <10, 38% in MELD score 11-18, and 13% in MELD score 19-24, p < 0.001). 37% of patients had blunted IGF-1 responses. Increments in IGF-1 levels correlated with albumin (r = 0.6), portal congestive index (r = 0.4), and MAMC (r = 0.25). By multivariate analysis, only CP (OR 5.7) and MELD scores (OR 4.5) accurately differentiated between blunted or non-blunted IGF-1 responses and not portal hypertension (OR 0.9) or malnutrition (OR 1.35). Conclusions: Cirrhosis is associated with low IGF-1 levels and an attenuated response to exogenous GH. These findings correlate better with the extent of hepatic dysfunction rather than the presence of portal hypertension or malnutrition. (C) 2008 European Association for the Study of the Liver. Published by Elsevier B.V.. All rights reserved.