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

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/1.73m2). 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.

Safety and efficacy of adding intravenous N-acetylcysteine to parenteral L-alanyl-L-glutamine in hospitalized patients undergoing surgery of the colon: a randomized controlled trial

“…17,20 However, others reported a shorter hospital stay after surgery in NAC-supplemented groups. 12 The results of our study showed shorter hospital stays in the study group than the control, but the difference was not statistically significant. The current study has several limitations, including the small sample size, short duration of NAC administration, and short period of patient follow up.…”

“…Venous blood samples were obtained before surgery (baseline laboratory evaluation), and on day two after surgery as in previous studies that made the postoperative evaluations between 1 hour to 72 hours after surgery. 11,12…”

The effect of intravenous infusion of N-acetyl cysteine in cirrhotic patients undergoing liver resection: A randomized controlled trial

“…Ibrahim et al . [ 25 ] in their study found similar results and demonstrated that liver functions were well preserved with the administration of NAC to their study group of cirrhotic patients undergoing major abdominal surgery. In other different types of surgeries as laparoscopic, Beyaz et al .…”

“…Ibrahim et al . [ 25 ] demonstrated that NAC preserved postoperative renal function in cirrhotic patients undergoing major abdominal surgeries assessed by cystatin C concentration and cystatin C glomerular filtration rate. However, in our RCT, no significant difference was observed in serum creatinine between both groups.…”

The Effect of N-acetyl Cysteine on Liver Function after On-pump Coronary Artery Bypass Graft Surgery: A Double-Blind Randomized Clinical Trial

“…In a study by Ibrahim and Sharawy, the effect of intravenous infusion of N-acetyl cysteine in cirrhotic patients undergoing abdominal surgery was investigated. Finally, it was shown that this intervention has led to the maintenance of liver and kidney function in these patients (21).…”