Abstract
Introduction
Large burn injuries lead to an extensive and prolonged catabolic state that results in loss of body mass and impaired wound healing. To combat this hypermetabolic response, different strategies have been employed including early excision and grafting, infection control, early nutrition and anabolic therapies such as oxandrolone. Human growth hormone is of interest for burn patients because of its anabolic properties. While its use has been associated with worse outcomes in the critically ill adult with sepsis, it has shown improved outcomes when used in pediatric burn patients.
The purpose of this study was to retrospectively evaluate the appropriateness of human growth hormone use, its adverse events and cost in patients with large burns or complex wounds and poor wound healing.
Methods
This was an IRB approved, retrospective, single center chart review from 2011 to 2019 assessing human growth hormone prescribing patterns in the burn unit. The primary objective was appropriateness of use, defined as documentation of poor wound healing prior to initiation despite adequate nutrition delivery and use of standard anabolic therapies (i.e. oxandrolone). Secondary objectives included perceived benefit, adverse events and median therapy cost per patient of human growth hormone.
Results
Thirty-eight patients were included in the study, 79% of which were adults, with a median total body surface area involvement of 50% (IQR 40 to 71). Only forty-one per cent of patients receiving human growth hormone met our predefined criteria for appropriateness; this was primarily driven by poor documentation of wound healing. However, 80% of patients were receiving adequate nutrition and oxandrolone, indicating appropriate clinical use. Most adult patients received a dose of 20mg daily, while pediatrics received the weight based 0.2mg/kg daily dose. The median duration of treatment was 24 days (IQR 13–35) and median time from admission to growth hormone initiation was 27 days (IQR 12–34). Overall clinical improvement was noted in 53% of patients, as evident by increased weight, prealbumin and/or documentation of improved wound healing. The most common adverse effect noted was hyperglycemia, followed by new sepsis onset. The median therapy cost per patient was $42,000.
Conclusions
Human growth hormone may serve as a salvage therapy for large burns with poorly healing wounds. Prior to initiating therapy, nutrition must be optimized and standard, more researched anabolic therapies should be started. While receiving therapy, patients should be monitored for both hyperglycemia and the development of new sepsis.
Sex Hormones, Growth Hormone, and the Cornea
