Letter: The Prognostic Role of IGF-1 in Chronic Liver Disease

Editors,

We read with great interest the article by Hartl et al., which characterises insulin-like growth factor-1 (IGF-1) signalling in patients with advanced chronic liver disease (ACLD). They found that IGF-1 levels progressively decreased with the advancement of cirrhosis and were particularly low in patients with clinically significant portal hypertension (CSPH). Notably, low IGF-1 levels were independently associated with higher body mass index (BMI), enhanced liver fibrosis (ELF) scores and increased mortality risk. The study underscores the prognostic value of IGF-1 in predicting decompensation, acute-on-chronic liver failure (ACLF) and liver-related death [1].

A study investigated the predictive value of serum IGF-1 levels in patients with cirrhosis. It found that low IGF-1 levels were significantly associated with higher mortality and increased risk of decompensation in compensated cirrhosis. Patients with lower IGF-1 had poorer survival rates than those with intermediate or high levels. In decompensated cirrhosis, IGF-1 levels did not significantly impact survival. IGF-1 was also an independent predictor of decompensation development, suggesting its potential utility for monitoring disease progression in compensated cirrhosis [2].

Contrarily, a study found that both low and high IGF-1 levels were linked to increased risks of death from cancer, CVD, and all causes, forming a U-shaped relationship. Interestingly, while high IGF-1 levels were associated with breast and prostate cancer risk, low IGF-1 levels were particularly predictive of mortality in individuals with liver conditions, such as cirrhosis and liver cancer. This highlights a different risk profile for low IGF-1 in cirrhosis compared with the general population, where both extremes of IGF-1 levels pose increased mortality risks [3].

One of the studies found interesting associations: They found that low IGF-1 levels were strongly associated with sarcopenia, frailty, osteodystrophy, and higher complication rates, including ascites and encephalopathy. Both IGF-1 and MELD-Na scores independently predicted 180-day mortality, with improved accuracy when combined. Patients with increased IGF-1 levels during follow-up had better survival and fewer complications, highlighting IGF-1 as a key marker of cirrhosis severity and prognosis [4].

Similarly, in diabetic patients, results showed that IGF-1 and its standard deviation score were inversely correlated with fibrosis markers. These findings suggest that lower IGF-1 levels are linked to liver fibrosis, highlighting IGF-1 as a potential indicator for advanced non-alcoholic steatohepatitis in diabetic patients [5].

In summary, the emerging consensus underscores the importance of IGF-1 not only as a biomarker for liver disease severity but also as a potential predictor of outcomes in diverse clinical settings. The ability to measure IGF-1 levels could enhance risk stratification in patients with ACLD, allowing clinicians to identify those at higher risk for decompensation and mortality. Moreover, integrating IGF-1 measurements into routine clinical practice may help guide therapeutic interventions and monitoring strategies, ultimately improving patient management and outcomes in chronic liver disease. Recognising the unique and shared prognostic implications of IGF-1 will be essential for developing targeted therapies and personalised management plans for patients suffering from chronic liver diseases.

Muhammad Osama: conceptualization, methodology, writing – review and editing, writing – original draft, supervision. Safiyyah Ubaid: methodology, visualization, data curation, writing – original draft, writing – review and editing. Maryam Ubaid: methodology, writing – original draft, writing – review and editing, data curation.

The authors declare no conflicts of interest.

The article is linked to Hartl et al. paper. https://doi.org/10.1111/apt.18289 and https://doi.org/10.1111/apt.18368.