Interleukin-10 and Zonulin are Associated With Post-Operative Delayed Gastric Emptying in Critically Ill Surgical Pediatric Patients - A Prospective Pilot Study.

BACKGROUND: Impaired gastric emptying (GE) is associated with morbidity in surgical critically ill children. The relationship between inflammation, gut barrier integrity (lipopolysaccharide binding protein, LBP; zonulin), and GE has not been described in this cohort. METHODS: Children requiring critical care after surgery and ≥2 years of age were enrolled. Pre- and post-operative levels of serum cytokines, LBP, and zonulin, and GE by the acetaminophen absorption test, were measured, allowing patients to serve as their own controls. Post-operative delayed GE was defined by a decrease in GE by ≥20% compared to pre-operative GE. The following were examined using non-parametric tests: changes in post- compared to pre-operative values, correlations between fold change (post-operative/ pre-operative) in study variables, and differences in fold change in study variables between patients with and without post-operative delayed GE. RESULTS: Twenty patients, median age 14 years (12.25, 18), 12 female, were included. Forty percent of patients had post-operative delayed GE. Post-operative IL-6, IL-8, IL-10 and LBP were increased, and zonulin was decreased (p-values <0.05). Fold increase in IL-10 and fold decrease in zonulin were inversely correlated (rho -0.618, P = 0.004). Fold increase in IL-10 (P = 0.0159) and fold decrease in zonulin (P = 0.0160) were greater in patients with post-operative delayed GE. Seventy-one percent of patients with both fold increase in IL-10 and decrease in zonulin had delayed GE. CONCLUSION: Post-operative changes in IL-10 and zonulin were associated with delayed GE in surgical critically ill children, which might suggest a compensatory mechanism to counterbalance post-operative inflammation and gut barrier dysregulation after surgery. This article is protected by copyright. All rights reserved.