Introduction: Despite improved supportive care, cardiogenic shock still has a significantly high mortality. Among many factors, multiple changes in the neuroendocrine system, are responsible for the high morbidity and mortality. Reduced circulating level of insuline-like growth factor and an elevated level of growth hormone are the reported characteristic findings early in the course of sepsis and. The role of insuline-like growth factor and growth hormone levels in patients with cardiogenic shock has not been described. Methods: The aim of this study was to evaluate the changes of growth hormone/ insuline-like growth factor 1 axis in patients with cardiogenic shock. Results: When admitted, the average GH value of the patient collective was 2.86 μg / l ± 0.78. The values of the majority of the patients (31/41 = 75.6%) were within the normal range. There we no differences among survivors and non-survivors over the 96h observational period. We did not observe differences between either elder and younger patients or female and male CS patients. On admission IGF-1 levels were 76.23 ± 5.67 μg/l (normal range 70– 270 μg/l) at the lower end of the normal range. Over the next 48-72 hours, the value dropped to 66.8 μg/l. However, the drop was not significant (p = 0.14). Non-survivors showed a more rapid decline compared to survivors which stayed within the normal range.Considering the subgroup analysis, it emerges that the average IGF-1 value of male patients remains above 70 μg/l and thus within the normal range, while the IGF-1 level of the female patients during the course which was up to 55.3 μg/l decreases in the course. Clearly female CS patients showed a steeper decline compared to the male patients. Further younger CS patients showed higher levels compared to patients above 70 years. Conclusion: There were no significant changes of growth hormone levels over time and we observed a decrease of insuline-like growth factor 1 in cardiogenic shock patients. In addition, in non-survivors we detected even lower levels of growth hormone and lower levels of insuline-like growth factor 1. We think that both growth hormone and insuline-like growth factor 1 may have l prognostic value to serve as a marker in cardiogenic shock.
Priyanka Boettger, Linda Bingener, M. Buerke