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Effectiveness of intravenous infusion of N-acetylcysteine in cirrhotic patients undergoing major abdominal surgeries.

Ibrahim ES, Sharawy A - Saudi J Anaesth (2015 Jul-Sep)

Bottom Line: Serum level of cystatin C was raised significantly above the basal value at postoperative day 1 and day 3 associated with significantly decreased in cystatin C GFR below the basal value in the control group (P = 0.001). 6 (20%) (PP = 0.03) in control group developed AKI based on cystatin C GFR criteria (GFR <55 ml/min/1.73m(2)).Mean values of alanine aminotransferase and aspartate aminotransferase were increased significantly above the basal values in both groups, but the increases were significantly lower in NAC group (P = 0.00).Chest infection was significantly lower associated with shorter hospital stay in the NAC group than the control group.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, National Liver Institute, Menofeya University, Menofeya, Egypt.

ABSTRACT

Background: Postoperative acute kidney injury (AKI) is common in patients with chronic liver disease. We prospectively evaluated effectiveness of the N-acetylcysteine (NAC) in preserving postoperative renal functions in cirrhotic patients undergoing major abdominal surgeries.

Materials and methods: A total of 60 cirrhotic patients child A to B were randomized into two groups of 30 each. NAC groupwas received intravenous infusion of NAC (1200 mg/12h starting immediately before surgery and continued for 72h h postoperative) and controls group received a similar volume of glucose 5% solution as a a placebo. Systemic hemodynamics, hepatic and renal functions, serum cystatin C and cystatin C glomerular filtration rate (GFR) (GFR) were compared between both groups.

Results: Serum level of cystatin C was raised significantly above the basal value at postoperative day 1 and day 3 associated with significantly decreased in cystatin C GFR below the basal value in the control group (P = 0.001). 6 (20%) (PP = 0.03) in control group developed AKI based on cystatin C GFR criteria (GFR <55 ml/min/1.73m(2)). Mean values of alanine aminotransferase and aspartate aminotransferase were increased significantly above the basal values in both groups, but the increases were significantly lower in NAC group (P = 0.00). Chest infection was significantly lower associated with shorter hospital stay in the NAC group than the control group.

Conclusion: Intravenous administration of NAC NAC in cirrhotic patients undergoing major abdominal surgeries reduces the incidence of cystatin C GFR-based AKI, postoperative renal and liver functions were well-preserved and improved outcome.

No MeSH data available.


Related in: MedlinePlus

Box and whiskers graph of cystatin C (mg/L) in the two studied groups. N-acetylcysteine group
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Figure 1: Box and whiskers graph of cystatin C (mg/L) in the two studied groups. N-acetylcysteine group

Mentions: There were no significant differences between the groups with regard to demographic data, clinical, and perioperative characteristics [Table 1]. There were no significant differences with regard to baseline indexes of renal function, child classification, co-morbid risk factors, physiological or operative POSSUM score, surgery type or duration, blood loss or postoperative hematology, of the two groups were remarkably similar overall. Hence Hence, it is, therefore therefore, very unlikely that patient characteristic variables might influence the results of the study significantly. There were were no significant differences between both groups regarding the physiological POSSUM score consequently it is very unlikely that preoperative Factors made a significant contribution to the difference in the the outcome. Furthermore Furthermore, the operative POSSUM scores were virtually identical indicating an even overall distribution of operative difficulty [Table 1]. There were no significant differences in the volume of crystalloids or colloids transfused to both groups [Table 2] with a mean value of 2470 (1680) ml and 570 (330) ml in the NAC group while mean values were 2530 (1760) ml and 590 (290) ml in the control group, respectively (P > 0.05). There was no statistically significant different between the two groups as regards serum creatinine and BUN BUN all over the time of study (P > 0.05) [Table 3]. There were no statistically significant different in preoperative values of serum cystatin C in both groups a mean value of 1.032 (0.169) versus (1.045 [0.166] mg/L, P = 0.68) associated with significant increase in serum cystatin C at postoperative day 1 and postoperative day 3 a mean value of (1.151 [0.184] and and 1.204 [0.201] 1.003 [0.111] and and 1.027 [0.142] mg/L, P = 0.00) in the control group and NAC group, respectively [Table 4 and Figure 1]. Estimation of GFR calculated according to Hoek et al. equation used the values of cystatin C showed that There were no statistically significant different in preoperative values of cystatin C GFR in both groups a mean value of (76.33 [11.329] 75 [11.199] ml/min/1.73 m2, PP = 0.52) that associated with significant decreased in cystatin C GFR at postoperative day 1 and postoperative day 3 a mean value of (68.53 [9.886] and 65.33 [10.162] vs vs. 76.26 [6.414] and 75.13 [7.696] ml/min/1.73 m2, PP = 0.00) in the control group and NAC group, respectively [Table 4 and Figure 2]. Of the 30 patients enrolled, 6 (20%) in the control group developed AKI as urine output <0.5 ml/kg/h for more than 12 h and based on results of cystatin C GFR criteria (GFR <55 ml/min/1.73 m2) they admitted to the ICU ICU. AKI resolved with medical intervention in five patients suggestive of reversible prerenal etiology. One patient developed AKI, due to either acute tubular necrosis or HRS that required the initiation of renal replacement therapy. Our results showed that the increase in AST and ALT from baseline values were significantly lower postoperative day 1 and postoperative day 3 in NAC group than in control group a mean values (67.53 [17.45] and and 73.20 [16.43] vs. 84.60 [15.14] and and 95.60 [17.27] IU/L, P = 0.00) and (74 [10.18] and 78.26 [17.27] vs. 94.73 [20.39] and 104.40 [23.35] IU/L, P = 0.00 <0.001), respectively [Table 3]. There were no significant differences between both groups regarding serum bilirubin (mg/dl), there was statistically significant prolonged in prothrombin time at postoperative day 1 and postoperative day 3 in both group with no statistically significant different between both groups (P > 0.05) [Table 3]. There was no statistical difference in systolic arterial pressure, MAP, diastolic arterial pressure, HR, and SpO2 values at the preoperative, postoperative day 1 and day 3 [Table 2]. Complications in the form of chest infection and postoperative intolerance to oral feeding were significantly lower in the NAC group than control group; this was accompanied with a significant reduction in the hospital stay, (P < 0.05) [Table 5].


Effectiveness of intravenous infusion of N-acetylcysteine in cirrhotic patients undergoing major abdominal surgeries.

Ibrahim ES, Sharawy A - Saudi J Anaesth (2015 Jul-Sep)

Box and whiskers graph of cystatin C (mg/L) in the two studied groups. N-acetylcysteine group
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4478819&req=5

Figure 1: Box and whiskers graph of cystatin C (mg/L) in the two studied groups. N-acetylcysteine group
Mentions: There were no significant differences between the groups with regard to demographic data, clinical, and perioperative characteristics [Table 1]. There were no significant differences with regard to baseline indexes of renal function, child classification, co-morbid risk factors, physiological or operative POSSUM score, surgery type or duration, blood loss or postoperative hematology, of the two groups were remarkably similar overall. Hence Hence, it is, therefore therefore, very unlikely that patient characteristic variables might influence the results of the study significantly. There were were no significant differences between both groups regarding the physiological POSSUM score consequently it is very unlikely that preoperative Factors made a significant contribution to the difference in the the outcome. Furthermore Furthermore, the operative POSSUM scores were virtually identical indicating an even overall distribution of operative difficulty [Table 1]. There were no significant differences in the volume of crystalloids or colloids transfused to both groups [Table 2] with a mean value of 2470 (1680) ml and 570 (330) ml in the NAC group while mean values were 2530 (1760) ml and 590 (290) ml in the control group, respectively (P > 0.05). There was no statistically significant different between the two groups as regards serum creatinine and BUN BUN all over the time of study (P > 0.05) [Table 3]. There were no statistically significant different in preoperative values of serum cystatin C in both groups a mean value of 1.032 (0.169) versus (1.045 [0.166] mg/L, P = 0.68) associated with significant increase in serum cystatin C at postoperative day 1 and postoperative day 3 a mean value of (1.151 [0.184] and and 1.204 [0.201] 1.003 [0.111] and and 1.027 [0.142] mg/L, P = 0.00) in the control group and NAC group, respectively [Table 4 and Figure 1]. Estimation of GFR calculated according to Hoek et al. equation used the values of cystatin C showed that There were no statistically significant different in preoperative values of cystatin C GFR in both groups a mean value of (76.33 [11.329] 75 [11.199] ml/min/1.73 m2, PP = 0.52) that associated with significant decreased in cystatin C GFR at postoperative day 1 and postoperative day 3 a mean value of (68.53 [9.886] and 65.33 [10.162] vs vs. 76.26 [6.414] and 75.13 [7.696] ml/min/1.73 m2, PP = 0.00) in the control group and NAC group, respectively [Table 4 and Figure 2]. Of the 30 patients enrolled, 6 (20%) in the control group developed AKI as urine output <0.5 ml/kg/h for more than 12 h and based on results of cystatin C GFR criteria (GFR <55 ml/min/1.73 m2) they admitted to the ICU ICU. AKI resolved with medical intervention in five patients suggestive of reversible prerenal etiology. One patient developed AKI, due to either acute tubular necrosis or HRS that required the initiation of renal replacement therapy. Our results showed that the increase in AST and ALT from baseline values were significantly lower postoperative day 1 and postoperative day 3 in NAC group than in control group a mean values (67.53 [17.45] and and 73.20 [16.43] vs. 84.60 [15.14] and and 95.60 [17.27] IU/L, P = 0.00) and (74 [10.18] and 78.26 [17.27] vs. 94.73 [20.39] and 104.40 [23.35] IU/L, P = 0.00 <0.001), respectively [Table 3]. There were no significant differences between both groups regarding serum bilirubin (mg/dl), there was statistically significant prolonged in prothrombin time at postoperative day 1 and postoperative day 3 in both group with no statistically significant different between both groups (P > 0.05) [Table 3]. There was no statistical difference in systolic arterial pressure, MAP, diastolic arterial pressure, HR, and SpO2 values at the preoperative, postoperative day 1 and day 3 [Table 2]. Complications in the form of chest infection and postoperative intolerance to oral feeding were significantly lower in the NAC group than control group; this was accompanied with a significant reduction in the hospital stay, (P < 0.05) [Table 5].

Bottom Line: Serum level of cystatin C was raised significantly above the basal value at postoperative day 1 and day 3 associated with significantly decreased in cystatin C GFR below the basal value in the control group (P = 0.001). 6 (20%) (PP = 0.03) in control group developed AKI based on cystatin C GFR criteria (GFR <55 ml/min/1.73m(2)).Mean values of alanine aminotransferase and aspartate aminotransferase were increased significantly above the basal values in both groups, but the increases were significantly lower in NAC group (P = 0.00).Chest infection was significantly lower associated with shorter hospital stay in the NAC group than the control group.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, National Liver Institute, Menofeya University, Menofeya, Egypt.

ABSTRACT

Background: Postoperative acute kidney injury (AKI) is common in patients with chronic liver disease. We prospectively evaluated effectiveness of the N-acetylcysteine (NAC) in preserving postoperative renal functions in cirrhotic patients undergoing major abdominal surgeries.

Materials and methods: A total of 60 cirrhotic patients child A to B were randomized into two groups of 30 each. NAC groupwas received intravenous infusion of NAC (1200 mg/12h starting immediately before surgery and continued for 72h h postoperative) and controls group received a similar volume of glucose 5% solution as a a placebo. Systemic hemodynamics, hepatic and renal functions, serum cystatin C and cystatin C glomerular filtration rate (GFR) (GFR) were compared between both groups.

Results: Serum level of cystatin C was raised significantly above the basal value at postoperative day 1 and day 3 associated with significantly decreased in cystatin C GFR below the basal value in the control group (P = 0.001). 6 (20%) (PP = 0.03) in control group developed AKI based on cystatin C GFR criteria (GFR <55 ml/min/1.73m(2)). Mean values of alanine aminotransferase and aspartate aminotransferase were increased significantly above the basal values in both groups, but the increases were significantly lower in NAC group (P = 0.00). Chest infection was significantly lower associated with shorter hospital stay in the NAC group than the control group.

Conclusion: Intravenous administration of NAC NAC in cirrhotic patients undergoing major abdominal surgeries reduces the incidence of cystatin C GFR-based AKI, postoperative renal and liver functions were well-preserved and improved outcome.

No MeSH data available.


Related in: MedlinePlus