title: Reduced plasma ghrelin levels on day 1 after esophagectomy: a new predictor of prolonged systemic inflammatory response syndrome.
abstract: OBJECTIVE
  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 ± 0.6 days, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2, E2, Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Hiura
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Kenji
authors.initials: K
authors.lastname: Kangawa
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D054439:Ghrelin / Q000097:blood* / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011184:Postoperative Period; D011446:Prospective Studies; D013491:Suppressor Factors, Immunologic / Q000378:metabolism; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis*; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D054439:Ghrelin; D013491:Suppressor Factors, Immunologic; C013256:soluble immune response suppressor