Surgical Inflammation Induces Hepcidin Production after Abdominal Surgery

Hepcidin, a key regulator of iron homeostasis, is also a marker of acute inflammation. In the present study we investigated the changes in the serum hepcidin level and correlations between hepcidin and other markers of acute inflammation during the perioperative period in patients after abdominal surgery. Serum hepcidin, hemoglobin (Hb), hematocrit (Ht), white blood cell (WBC) count, frequency of neutrophils, and C-reactive protein (CRP) were measured preoperatively (Pre), and on postoperative days (POD) 1, 3, 7, and 14. In patients undergoing gastrectomy, the median levels of hepcidin preoperatively and on POD 1, 3, 7, and 14 were 6.5, 53.1, 31.7, 15.6, and 4.0 ng/dl, respectively (p < 0.0001). The corresponding levels in colectomy patients were 8.5, 78.3, 60.1, 49.7, and 8.4 ng/dl, respectively (p = 0.0002); those in hepatectomy patients were 6.6, 16.3, 3.5, 13.4, and 3.4 ng/dl, respectively (p = 0.0022); and those in patients undergoing surgery for diffuse peritonitis were 24.8, 50.1, 43.1, 31.2, and 31.7 ng/dl, respectively (p = 0.4933). There were no significant decreases in Hb and Ht in the patients undergoing gastrectomy, colectomy, or surgery for diffuse peritonitis. The level of hepcidin was significantly correlated with the WBC count, frequency of neutrophils, and CRP level during the perioperative period for all four types of operation. Like other inflammatory markers, an increase in the level of hepcidin (i.e., a hepcidin storm) occurs in the acute phase after gastrectomy, colectomy, hepatectomy, and surgery for diffuse peritonitis.