The role of ghrelin in critically-ill patients with sepsis

Abstract

Background: Ghrelin is a peptide mainly produced by cells of the gastric mucosa; Ghrelin’s active form is the main modulator of a variety of biological actions, while both forms are involved in systemic inflammation. Aim: We investigated ghrelin levels at different stages of sepsis in critical illness, as well as associations with proinflammatory mediators and organ dysfunction markers. Methods: All consecutive admissions to our hospital ICU were screened for eligibility. Non-septic patients upon ICU admission who subsequently developed sepsis and septic shock (Crit Care Med 1992, 20(6):864-874) were enrolled (n=25). Clinical data and scores were recorded, and blood samples were obtained at baseline (upon ICU admission), and upon sepsis and septic shock development. Total and active ghrelin, leptin, and cytokine serum concentrations were measured. Results: Total ghrelin and active ghrelin concentrations in serum were significantly elevated in septic shock compared to baseline (mean±SEM: 236.5±66.6 vs 57±12.5pg/ml, and 149.6±64.3 vs 15±7.4pg/ml, respectively). Leptin, TNF-α, and IL-6 levels did not differ significantly. Notably, active ghrelin levels on ICU admission correlated inversely with the length of patient mechanical ventilation (r=-0.487, p=0.016) and active ghrelin levels at sepsis stage correlated inversely with the length of stay in ICU (r=-0.584, p=0.0005). Conclusions: We demonstrated that in a well-defined cohort of ICU patients active and total ghrelin increase at septic shock. In addition, active ghrelin levels might have a protective role during the septic process. This work was supported by an unrestricted research grant by GSK