Clinically Evident Portal Hypertension (CEPH) is Associated with Low IGF-1 in Children with Chronic Liver Disease
1Division of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 2Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 3Division of Infectious Disease, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
Meeting: 2021 American Transplant Congress
Abstract number: 1178
Keywords: Growth disorders, Inflammation, Pediatric, Quality of life
Topic: Clinical Science » Liver » Liver: Pediatrics
Session Information
Session Name: Liver: Pediatrics
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: Children with chronic liver disease exhibit growth hormone resistance which is an additional risk factor for sarcopenia and growth failure in this vulnerable population. Low IGF-1 is associated with multiple negative effects including fatigue in other pro-inflammatory states, such as inflammatory bowel disease. Portal hypertension has not yet been studied as a risk factor for low IGF-1.
*Methods: Children ages 3 months to 18 years with chronic liver disease were enrolled from an ambulatory clinic at a single center. Patients with comorbidities affecting intestinal inflammation or the growth hormone axis were excluded. Clinical data, nutritional assessmen, and serum samples for IGF-1 were obtained at enrollment. Patients were categorized by the presence or absence of portal hypertension using published criteria for CEPH. IGF-1 Z scores were analyzed as both continuous and dichotomous variable with low IGF-1 defined as Z score < -2. Low mid upper arm circumference (MUAC) was defined as Z score <-1. For children >5 years, both child and guardian completed the PedsQL Multidimensional Fatigue Scale (PedsQL MF) and were compared with a published cohort of 157 healthy children.
*Results: 27 patients with median age 12.2 years were enrolled with the most common diagnoses being autoimmune hepatitis/primary sclerosing cholangitis and biliary atresia. 37% (n=10) patients had CEPH. The median IGF-1 Z score was -1.5. Children with CEPH had lower IGF-1 compared to patients without CEPH (p .003). Median height and weight Z scores in our cohort were close to 0 and when tested linearly, had no association with IGF-1. Low MUAC was associated with low IGF-1 (p .036). Median PedsQL MF scores from child and parent proxy were 63.89 and 75.70 respectively. Both were significantly lower compared to healthy children. Low IGF-1 levels were significantly associated with child reported fatigue (p .028).
*Conclusions: Children with CEPH have low IGF-1 even in this population of stable patients with preserved linear growth. Lower IGF-1 Z scores are associated with an increased burden of child reported fatigue. Next steps will include measurement of serum cytokines and evaluation of the relationship between a pro-inflammatory state and IGF-1 Z scores.
To cite this abstract in AMA style:
Whitehead B, Mohammad S, Kelly S, Josefson J, Mithal L, Alonso EM. Clinically Evident Portal Hypertension (CEPH) is Associated with Low IGF-1 in Children with Chronic Liver Disease [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/clinically-evident-portal-hypertension-ceph-is-associated-with-low-igf-1-in-children-with-chronic-liver-disease/. Accessed December 12, 2024.« Back to 2021 American Transplant Congress