Recombinant human growth hormone for treating burns and donor sites

Roelf S Breederveld; Wim E Tuinebreijer

doi:10.1002/14651858.CD008990.pub3

Cochrane Database of Systematic Reviews

Hormona de crecimiento humana recombinante para el tratamiento de las quemaduras y los sitios donantes

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DOI:

https://doi.org/10.1002/14651858.CD008990.pub3 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

15 septiembre 2014see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Heridas

Copyright:

Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

Roelf S Breederveld

Surgery and Burn Centre, Red Cross Hospital, Beverwijk, Netherlands
Wim E Tuinebreijer

Correspondencia a: Surgery and Burn Centre, Red Cross Hospital, Beverwijk, Netherlands

[email protected]

[email protected]

Contributions of authors

Roelf S. Breederveld: conceived the review question, developed the review, completed the first draft, made an intellectual contribution to the review and approved the final version prior to submission.
Wim E. Tuinebreijer: developed the review, co‐ordinated the review development, completed the first draft of the review, made an intellectual contribution to the review and approved the final version prior to submission.

Contributions of the editorial base:

Nicky Cullum edited the review; advised on the methodology, interpretation and content; and approved the final review prior to submission.
Sally Bell‐Syer co‐ordinated the editorial process; advised on the methodology, interpretation and content; and edited the review and the updated review.
Amanda Briant ran some of the searches.

Sources of support

Internal sources

Red Cross Hospital, Beverwijk, Netherlands.

Use of library and internet facilities.

External sources

The National Institute for Health Research (NIHR) is the sole funder of the Cochrane Wounds Group, UK.

Declarations of interest

There are no known conflicts of interests.

Acknowledgements

The authors would like to acknowledge the contribution of the peer referees who commented on this review: Wounds Group editors (Marian Brady, Dirk Ubbink, Ruth Foxlee), referees (Jane Burch, Richard Kirubakaran, Heather Cleland, Arturo Marti‐Carvajal, Amy Zelmer) and copy editor Jenny Bellorini.

Version history

Published

Title

Stage

Authors

Version

2014 Sep 15

Recombinant human growth hormone for treating burns and donor sites

Review

Roelf S Breederveld, Wim E Tuinebreijer

https://doi.org/10.1002/14651858.CD008990.pub3

2012 Dec 12

Recombinant human growth hormone for treating burns and donor sites

Review

Roelf S Breederveld, Wim E Tuinebreijer

https://doi.org/10.1002/14651858.CD008990.pub2

2011 Feb 16

Recombinant human growth hormone for treating burns and donor sites

Protocol

Roelf S Breederveld, Wim E Tuinebreijer

https://doi.org/10.1002/14651858.CD008990

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adolescent; Adult; Aged; Child; Child, Preschool; Humans; Infant; Middle Aged; Young Adult;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Figure 2

Study flow diagram.

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Analysis 1.1

Comparison 1 Comparison of rhGH with placebo, Outcome 1 Healing time of burn wounds in days for adults.

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Analysis 1.2

Comparison 1 Comparison of rhGH with placebo, Outcome 2 Donor site healing time in days for adults.

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Analysis 1.3

Comparison 1 Comparison of rhGH with placebo, Outcome 3 Donor site healing time in days for children.

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Analysis 1.4

Comparison 1 Comparison of rhGH with placebo, Outcome 4 Length of hospital stay.

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Analysis 1.5

Comparison 1 Comparison of rhGH with placebo, Outcome 5 Mortality.

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Analysis 1.6

Comparison 1 Comparison of rhGH with placebo, Outcome 6 Adverse events.

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Analysis 1.7

Comparison 1 Comparison of rhGH with placebo, Outcome 7 Adverse event: Septicaemia in adults.

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Analysis 2.1

Comparison 2 Comparison of rhGH with oxandrolone, Outcome 1 Donor site healing in days.

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Analysis 2.2

Comparison 2 Comparison of rhGH with oxandrolone, Outcome 2 Hyperglycaemia (blood glucose > 225 mg/dl).

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Summary of findings for the main comparison. Recombinant human growth hormone compared with placebo for treating burns and donor sites

Recombinant human growth hormone compared with placebo for treating burns and donor sites
Patient or population: Settings: burn centres Intervention: recombinant human growth hormone Comparison:
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
		Recombinant human growth hormone
Healing time of burn wounds in days for adults		The mean healing time of burn wounds in days for adults in the intervention groups was 9.07 lower (4.39 to 13.76 lower)		36 (2 studies)	⊕⊕⊝⊝ low^1,2,3,4
Donor site healing time in days for adults		The mean donor site healing time in days for adults in the intervention groups was 3.15 lower (1.54 to 4.75 lower)		36 (2 studies)	⊕⊕⊝⊝ low^1,2,3,4
Donor site healing time in days for children		The mean donor site healing time in days for children in the intervention groups was 1.70 lower (0.87 to 2.53 lower)		73 (2 studies)	⊕⊕⊝⊝ low¹³
Mortality in adults and children	Study population⁵		RR 0.53 (0.22 to 1.29)	324 (5 studies)	⊕⊕⊝⊝ low^5,6,7
	7 per 100	4 per 100 (2 to 9)
	Low⁵
	5 per 100	3 per 100 (1 to 6)
	High⁵
	13 per 100	7 per 100 (3 to 17)
Septicaemia in adults	Study population⁸		RR 0.61 (0.31 to 1.22)	267 (4 studies)	⊕⊕⊝⊝ low^1,8,9
	13 per 100	8 per 100 (4 to 16)
	Low⁸
	4 per 100	2 per 100 (1 to 5)
	High⁸
	13 per 100	8 per 100 (4 to 16)
Hyperglycaemia in adults and children	Study population¹⁰		RR 2.65 (1.68 to 4.16)	340 (5 studies)	⊕⊕⊝⊝ low^2,10,11
	11 per 100	30 per 100 (19 to 48)
	Low¹⁰
	0 per 100	0 per 100 (0 to 0)
	High¹⁰
	19 per 100	50 per 100 (32 to 79)
Length of hospital stay in days for adults		The mean length of hospital stay in days for adults in the intervention groups was 12.55 lower (8 to 17.09 lower)		99 (4 studies)	⊕⊕⊝⊝ low^1,12
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Method of randomisation, allocation concealment and blinding not reported. ² Small sample sizes of studies and wide confidence interval of estimate. ³ Patients in study of Sun 1998 had larger and deeper burns. ⁴ In the studies of Sun 1998 and Luo 2000 the way of assessment of the healing time was not reported. ⁵ The low and high risk values are the two extreme numbers of mortality in the control groups from two studies. ⁶ Method of randomisation and blinding in four studies and allocation concealment in five studies not reported. ⁷ Mortality is a rare outcome and the number of included patients in three studies was small. ⁸ The low and high risk values are the two extreme numbers of septicaemia in the control groups from two studies. ⁹ Septicaemia is a rare outcome and the number of included patients in three studies was small. ¹⁰ The low and high risk values are the two extreme numbers of hyperglycaemia in the control groups from two studies. Small sample sizes in four studies and wide confidence interval of estimate. ¹¹ Method of randomisation and blinding in three studies and allocation concealment in five studies not reported. ¹² Small sample sizes in four studies and wide confidence interval of estimate. Patients in control group of study of Lu 2004 received glutamine orally and no placebo injections. ¹³ Method of randomisation in one study and allocation concealment in two studies not reported.

Summary of findings for the main comparison. Recombinant human growth hormone compared with placebo for treating burns and donor sites

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Comparison 1. Comparison of rhGH with placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Healing time of burn wounds in days for adults Show forest plot	2	36	Mean Difference (IV, Fixed, 95% CI)	‐9.07 [‐13.76, ‐4.39]

2 Donor site healing time in days for adults Show forest plot	2	36	Mean Difference (IV, Fixed, 95% CI)	‐3.15 [‐4.75, ‐1.54]

3 Donor site healing time in days for children Show forest plot	2	73	Mean Difference (IV, Fixed, 95% CI)	‐1.70 [‐2.53, ‐0.87]

4 Length of hospital stay Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.1 Adults	4	99	Mean Difference (IV, Fixed, 95% CI)	‐12.55 [‐17.09, ‐8.00]
4.2 Children	1	28	Mean Difference (IV, Fixed, 95% CI)	‐7.0 [‐29.94, 15.94]
5 Mortality Show forest plot	5	324	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.22, 1.29]

5.1 Adults	4	296	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.19, 1.25]
5.2 Children	1	28	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.08, 16.67]
6 Adverse events Show forest plot	5	340	Risk Ratio (M‐H, Fixed, 95% CI)	2.65 [1.68, 4.16]

6.1 Hyperglycaemia (adults)	4	300	Risk Ratio (M‐H, Fixed, 95% CI)	2.43 [1.54, 3.85]
6.2 Hyperglycaemia (children)	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	10.74 [0.65, 178.65]
7 Adverse event: Septicaemia in adults Show forest plot	4	267	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.31, 1.22]

Comparison 1. Comparison of rhGH with placebo

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Comparison 2. Comparison of rhGH with oxandrolone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Donor site healing in days Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

2 Hyperglycaemia (blood glucose > 225 mg/dl) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 2. Comparison of rhGH with oxandrolone

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