Critical illness leads to a loss of lean body mass (LBM) and is associated with impaired immune function and wound healing, increased infection, and poorer outcomes [1,2]. Aggressive nutritional support can decrease net catabolic losses by only ~50%, therefore other methods need to be examined. We initiated anabolic steroid therapy (AS) (nandrolone intramuscular injection, once weekly × three doses) on 10 critically ill patients. Criteria for AS: moderate to severe malnutrition, ICU stay > 14 days, tolerating enteral feeds, and exhibiting poor response to nutritional support. Feeds were 130–150% of measured energy expenditure and protein at 2.0–2.5 g/kg per day. Response was monitored by nitrogen balance and LBM.
Eight of 10 patients exhibited a good response to AS, with attainment of positive nitrogen balance and improvement in skeletal and visceral protein levels. AS may be useful as adjunctive therapy for malnourished, critically ill patients for protein repletion.
Table 1.
| 2 weeks prior to AS | After 3 doses | |||||
|---|---|---|---|---|---|---|
| Patient | Pre-ALB | N balance (g/day) | LBM (kg) | Pre-ALB | N balance (g/day) | LBM (kg) |
| 1. F | 0.09 | +2.3 | 22.3 | 0.09 | +3.2 | 22.8 |
| 2. F | 0.08 | -3.4 | 18.4 | 0.21 | +4.8 | 19.2 |
| 3. M | 0.11 | -5.8 | 36.3 | 0.32 | +7.2 | 38.1 |
| 4. M | < 0.07 | -6.7 | 27.2 | 0.19 | +1.8 | 27.9 |
| 5. M | 0.18 | -14.2 | 39.4 | 0.28 | +6.9 | 40.8 |
| 6. F | 0.07 | -5.2 | 12.8 | 0.16* | +5.3* | 15.3* |
| 7. M | 0.14 | -6.8 | N/A | 0.35 | +3.8 | N/A |
| 8. M | < 0.07 | -10.2 | 29.1 | 0.16 | +5.4 | 29.9 |
| 9. M | 0.15 | -17.6 | 20.5 | 0.14 | -10.0 | 22.1 |
| 10. M | 0.10 | -19.6 | 26.8 | 0.14 | +4.6 | 25.8 |
* Data collected 6 weeks post steroid.