Reduced plasma ghrelin levels on day 1 after esophagectomy: A new predictor of prolonged systemic inflammatory response syndrome

Background and purpose: Ghrelin, a stomach-derived hormone, stimulates growth hormone secretion and appetite, and inhibits excessive inflammatory response. Plasma ghrelin might affect the inflammatory response to stressful surgical interventions. The aim of this study was to investigate the relationship between serial changes in plasma ghrelin concentrations and the postoperative clinical course after esophagectomy. Methods: The prospective cohort study subjects were 20 patients with esophageal cancer, who underwent esophagectomy with gastric tube reconstruction. Blood samples were taken six times perioperatively during the course of esophagectomy. Results: The plasma ghrelin level decreased to 33% (range 15-90%) on postoperative day (POD) 1, relative to the preoperative level, then recovered to about 50% by POD 3-10. The duration of systemic inflammatory response syndrome (SIRS) was significantly longer in patients with a marked ghrelin reduction to <33% on POD 1, than in those with less marked reduction of ≥33% (6.1±1.3 vs. 2.1±0.6days, P=0.019). On POD 1, the only inflammatory marker that correlated with the duration of SIRS was the % ghrelin, whereas C-reactive protein, leukocyte count, and IL-6 did not. Conclusion: An early postoperative drop in plasma ghrelin correlated with prolonged SIRS after esophagectomy. Thus, the supplementation of low plasma ghrelin may help minimize excess inflammatory response in these patients.