Relationship of E2 with IGF-1 and Mortality in Male Patients with Decompensated Cirrhosis

Background: Cirrhosis is related to low levels of circulating insulin-like growth factor (IGF-1), which itself is caused by decreased synthesis by functional hepatic parenchyma. IGF-1 is also correlated with endogenous E2 and T in adolescents and decreased estradiol replacement. The acute changes in IGF-1 are further consequences of changes in serum insulin in response to food intake. A partial inhibition of IGF-1 receptor signaling in the heart induces cardioprotective effects, such as lower rates of cardiac hypertrophy. However, the relationship between IGF-1, steroid hormones and cardiac function remains unclear in specific cohorts of acutely ill patients. Purpose: The objective of the following study was to test for significant associations of insulin-like growth factor, IGF-1, with different levels of steroid hormones (17β-estradiol—E2; total testosterone—T; aldosterone; testosterone-to-estradiol ratio—T/E2), hepatic and cardiac functional indices and all-cause death rate in male patients with alcohol-associated cirrhosis. Materials and Methods: In a group of 64 male patients with cirrhosis secondary to alcohol overuse (age 60.6 ± 11.9 years), steroid hormones were measured with immune-enzyme methods. Results: Higher MELD 3.0 was the only variable associated with 1.238 times higher risk for detection of the low quartile (Q1) of IGF-1 (OR 1.238, 1.007–1.521, p = 0.042). According to the multivariable enter regression analysis, age increases the risk of death by a factor of 1.105; testosterone decreases this risk by 0.854, and IGF-1 by 0.983 (as a trend) (OR 1.105, OR 1.005–1.216, p = 0.039 for age; OR 0.854, 0.697–0.998, p = 0.047 for T; OR 0.983, 0.964–1.002, p = 0.085 for IGF-1). CRP and T/E2 were associated with mortality in univariable linear regression analysis. Conclusions: The levels of IGF-1 are directly related to severity of disease and tend to relate to death risk, which is substantially inversely associated with age and plasma total testosterone.