Diagnostic Accuracy of Plasma Ghrelin Concentrations in Pediatric Sepsis-Associated Acute Respiratory Distress Syndrome: A Single-Center Cohort Study

Abstract

Background: Ghrelin is the endogenous ligand of growth hormone secretagogue receptor 1a, which plays a role in regulating immunity and inflammation. The aim of this study is to assess the diagnostic value of plasma ghrelin in sepsis-associated pediatric acute respiratory distress syndrome (PARDS).Methods: We recruited patients who were admitted to the pediatric ICU (PICU) of the Children's Hospital of Chongqing Medical University between January 2019 and January 2020 and met the diagnostic criteria for sepsis. Data on clinical variables, laboratory indicators, plasma ghrelin concentrations, and inflammatory factors were collected and evaluated, and patients were followed up for 28 days. The area under the receiver-operating characteristic curves (AUROC) were determined using logistic regression to calculate and test cut-off values for ghrelin as a diagnostic indicator of sepsis-associated PARDS. The log-rank test was used to compare survival according to ghrelin levels.Main results: Sixty-six PICU patients (30 with ARDS and 36 without ARDS) who met the diagnostic criteria of sepsis were recruited. The ghrelin level was significantly higher in the ARDS group than in the non-ARDS group. The AUROC of ghrelin was 0.708 (95% confidence interval: 0.584–0.833) and the positivity cutoff value was 445 pg/mL. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of plasma ghrelin for the diagnosis of PARDS-associated sepsis were 86.7, 50.0, 59.1, 81.8, 1.734, and 0.266%, respectively. The survival rate of sepsis patients were significantly improved when the ghrelin level was >445 pg/mL.Conclusions: Ghrelin plasma levels were higher in sepsis-associated PARDS, and accompanied by increased levels of inflammatory factors. High ghrelin levels are a positive predictor of ICU survival in sepsis patients. Yet, there is no evidence to prove that elevated ghrelin is a promising diagnostic indicator of sepsis-associated PARDS.Trial registration: Clinicaltrials, ChiCTR1900023254. Registered 1 December 2018 - Retrospectively registered, http://www.clinicaltrials.gov/ChiCTR1900023254.

Effect of nutrition status and inflammatory stimuli on ghrelin and peptide‐YY levels among critically ill children: A prospective and observational study

“…Indeed, in our population, we found a significant association between CRP and ghrelin. Proinflammatory mediators have been directly associated with ghrelin in pediatric critical illness, and patients with early sepsis—a well‐defined proinflammatory state—reported having high ghrelin levels 30,31 . Although our study is likely underpowered to identify multiple association with inflammatory mediators, we did find CRP to have a significant association with ghrelin even after correction for age and severity of illness.…”

“…Proinflammatory mediators have been directly associated with ghrelin in pediatric critical illness, and patients with early sepsis-a well-defined proinflammatory state-reported having high ghrelin levels. 30,31 Although our study is likely underpowered to identify multiple association with inflammatory mediators, we did find CRP to have a significant association with ghrelin even after correction for age and severity of illness. Others have also reported associations with other inflammatory mediators, such as IL-6 and TNF-α (although not corrected for age).…”

“…Others have also reported associations with other inflammatory mediators, such as IL-6 and TNF-α (although not corrected for age). 30 PYY levels in our cohort were affected by macronutrient intake, age, and inflammation. A higher intake of energy and fat during the last 24 h was associated with increased serum PYY levels.…”

“…Although our study is likely underpowered to identify multiple association with inflammatory mediators, we did find CRP to have a significant association with ghrelin even after correction for age and severity of illness. Others have also reported associations with other inflammatory mediators, such as IL‐6 and TNF‐α (although not corrected for age) 30 …”

Pathobiology, Severity, and Risk Stratification of Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…Interestingly, children in this cohort with a history of hematopoietic cellular transplantation (HCT) had higher levels of IL-8, IL-18, IL-10, and TNFR2 (108). A small single-site study indicated that ghrelin, a peptide the regulates immunity, is elevated in children with sepsis-associated PARDS (142).…”