Sullivan D H, Carter W J
Geriatric Research Education and Clinical Center, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205.
J Am Coll Nutr. 1994 Apr;13(2):184-91. doi: 10.1080/07315724.1994.10718393.
The primary objective of this cross-sectional study was to test the hypothesis that the plasma concentration of insulin-like growth factor I (IGF-I) correlates with the risk of in-hospital morbidity among metabolically stable elderly. The secondary objective was to determine whether IGF-I correlates with other putative indicators of protein-energy nutritional status.
To meet these objectives, 110 randomly selected admissions to a Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital were studied. The average age of the study patients was 76 years; 98% were male, and 78% were white.
At admission, each patient completed a comprehensive medical, functional, neuropsychological, and nutritional assessment including the attainment of a plasma IGF-I determination. While in the hospital, each subject was monitored daily for development of complications.
Subsequent to GRU admission, 44 patients (40%) experienced at least one complication; 36 patients (33%) experienced an infectious complication, 8 patients (7%) experienced a life-threatening complication, and 5 patients (5%) experienced a life-threatening infectious complication. There was no correlation between IGF-I and development of a non-life-threatening complication ("any complication" or "any infectious complication"). However, IGF-I was a strong predictor of "life-threatening" and "life-threatening infectious" complications. The logistic regression model incorporating the independent variable IGF-I differentiated the patients who would develop a "life-threatening" complication from those who would not with a sensitivity of 75%, a specificity of 76%, and an overall predictive accuracy of 76%. IGF-I was highly correlated with admission serum albumin, transferrin, and cholesterol, triceps skinfold thickness, body weight expressed as a percent of ideal, and body mass index. There was no correlation between IGF-I and the Katz Index of Activities of Daily Living score, age, or anergy status.
IGF-I is a strong predictor of "life-threatening" and "life-threatening infectious" complications and may be a clinically useful marker for protein-energy undernutrition among metabolically stable hospitalized elderly patients.
本横断面研究的主要目的是检验这样一个假设，即胰岛素样生长因子I（IGF-I）的血浆浓度与代谢稳定的老年人住院期间发病风险相关。次要目的是确定IGF-I是否与蛋白质能量营养状况的其他假定指标相关。
为实现这些目标，对一家退伍军人管理局医院老年康复科（GRU）随机选取的110名入院患者进行了研究。研究患者的平均年龄为76岁；98%为男性，78%为白人。
入院时，每位患者完成了全面的医学、功能、神经心理学和营养评估，包括测定血浆IGF-I。住院期间，每天监测每位受试者并发症的发生情况。
入住GRU后，44名患者（40%）发生了至少一种并发症；36名患者（33%）发生了感染性并发症，8名患者（7%）发生了危及生命的并发症，5名患者（5%）发生了危及生命的感染性并发症。IGF-I与非危及生命并发症（“任何并发症”或“任何感染性并发症”）的发生之间无相关性。然而，IGF-I是“危及生命”和“危及生命的感染性”并发症的有力预测指标。纳入自变量IGF-I的逻辑回归模型将发生“危及生命”并发症的患者与未发生者区分开来，灵敏度为75%，特异度为76%，总体预测准确率为76%。IGF-I与入院时血清白蛋白、转铁蛋白、胆固醇、肱三头肌皮褶厚度、实际体重占理想体重的百分比以及体重指数高度相关。IGF-I与日常生活活动能力的Katz指数评分、年龄或无反应状态之间无相关性。
IGF-I是“危及生命”和“危及生命的感染性”并发症的有力预测指标，可能是代谢稳定的住院老年患者蛋白质能量营养不良的一个临床有用标志物。
