Multivariate analysis of factors associated with renal dysfunction in patients with obstructive jaundice

Padillo, Francisco J.; Cruz, Antonio Míguez Santa; Briceño, Javier; Martín‐Malo, Alejandro; Pera-Madrazo, C; Sitges‐Serra, Antonio

doi:10.1002/bjs.5091

Cited by 31 publications

(22 citation statements)

References 21 publications

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“…27 Next to an increased risk for development of infectious complications, obstructive jaundice has been associated with renal dysfunction, with its extent depending on the intensity of biliary obstruction. 10,29,30 In the pathogenesis of renal failure, extracellular volume depletion may be an important factor, and while the observed increases in plasma renin and aldosterone are logical endocrine responses to a reduced extracellular water compartment, there also is a paradoxical rise in plasma atrial natriuretic peptide (ANP) in response to biliary obstruction. 31 The raised plasma ANP level might be the result of the passage of bile components to the blood and is reversed to basal levels after biliary drainage, thereby improving renal dysfunction.…”

Section: Experimental Studiesmentioning

confidence: 99%

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Gaag

Kloek

Castro

et al. 2009

Journal of Gastrointestinal Surgery

159

114

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Rationale Preoperative biliary drainage (PBD) has been introduced to improve outcome after surgery in patients suffering from obstructive jaundice due to a potentially resectable proximal or distal bile duct/pancreatic head lesion. In experimental models, PBD is almost exclusively associated with beneficial results: improved liver function and nutritional status; reduction of systemic endotoxemia; cytokine release; and, as a result, an improved immune response. Mortality was significantly reduced in these animal models. Human studies show conflicting results. Findings For distal obstruction, currently the "best-evidence" available clearly shows that routine PBD does not yield the appreciated improvement in postoperative morbidity and mortality in patients undergoing resection. Moreover, PBD harbors its own complications. However, most of the available data are outdated or suffer from methodological deficits. Conclusion The highest level of evidence for PBD to be performed in proximal obstruction, as well as over the preferred mode, is lacking but, nevertheless, assimilated in the treatment algorithm for many centers. Logistics and waiting lists, although sometimes inevitable, could be factors that might influence the decision to opt for PBD, as well as an extended diagnostic workup with laparoscopy (on indication) or scheduled preoperative chemotherapy.

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Section: Experimental Studiesmentioning

confidence: 99%

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Gaag

Kloek

Castro

et al. 2009

Journal of Gastrointestinal Surgery

159

114

View full text Add to dashboard Cite

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“…The main treatment for obstructive jaundice includes surgical removal of obstruction and endoprosthesis introduced either percutaneously or endoscopically. This mechanism of liver injury during obstructive jaundice is involved in chemical mediators such as superoxide, nitric oxide (NO), endothelin 1 (ET-1) and cytokines [2,3,4,5]. Among these cytokines, ET-1 and NO have been considered to be the main effectors in liver injury [3,4,5].…”

Section: Introductionmentioning

confidence: 99%

“…This mechanism of liver injury during obstructive jaundice is involved in chemical mediators such as superoxide, nitric oxide (NO), endothelin 1 (ET-1) and cytokines [2,3,4,5]. Among these cytokines, ET-1 and NO have been considered to be the main effectors in liver injury [3,4,5]. Obviously, it is important to reduce the release of ET-1and NO in the perioperative period in order to prevent or minimize the related complications.…”

Section: Introductionmentioning

confidence: 99%

“…ruetten et al [14] observed that the selective ET B receptor antagonist attenuated the degree of hepatocellular injury and dysfunction caused by endotoxin. Therefore, ET-1 has been considered to be one of the main effectors in the process of obstructive jaundice [3,4,11]. NO, a strong vasodilator is generated by all major cell type of liver, including hepatocytes, Kupffer, stellate, and sinusoidal endothelial cells.…”

mentioning

confidence: 99%

“…The equilibrium between NO and ET-1 is essential in maintaining liver's blood supply. Biliary obstruction leads to excessive production of ET and NO [2,3,4,5], which causes the destruction of this dynamic equilibrium and the disorders of hepatic hemodynamics, which further aggravates liver injury. Consistent with previous research, our data demonstrated that ET-1 and NO levels in both plasma and liver tissue in CBD-ligated rats were significantly elevated in comparison with the Sham-Operated group.…”

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confidence: 99%

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The hepatic protective mechanism of Ginkgo biloba extract in rats with obstructive jaundice

Weng

Zhou

Jia

et al. 2011

Bosn J of Basic Med Sci

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The objective of our study was to examine the hepatic protective mechanism of Ginkgo biloba extract (GBE) in rats with obstructive jaundice (OJ). Twenty rats underwent bile duct ligation and received daily intraperitoneal injections of either control saline or Ginkgo biloba extract for 14 days. Ten sham-operated rats had their bile duct exposed but not ligated or sectioned. Serum alanine transaminase (ALT) was analyzed for liver function tests and liver damage was further assessed by histologic examination. The levels of endothelin 1 (ET-1) and nitric oxide (NO) in blood and liver homogenate were measured. The serum alanine transaminase was elevated in the bile duct ligation rats (BDL rats); GBE could significantly lower serum transaminase level and ameliorate liver histological damage. ET-1 and NO levels in both plasma and liver tissue were also elevated in common bile duct (CBD)-ligated rats, but this increase was significantly decreased by GBE treatment. Moreover, the degree of liver damage severity positively correlates with high levels of ET-1 and NO. GBE mediated the liver protective effect at least in part by suppressing overproduction of ET-1and NO and restoring a proper balance between ET-1and NO to some extent.

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Optimal timing of pancreaticoduodenectomy following preoperative biliary drainage considering major morbidity and postoperative survival

Shin

Han

Ryu

et al. 2019

J Hepato Biliary Pancreat

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BackgroundThe present study aimed to determine the optimal timing of pancreaticoduodenectomy (PD) following preoperative biliary drainage (PBD) with consideration of postoperative morbidity and survival.MethodsBetween January 2007 and December 2015, consecutive 1,568 patients underwent PD at a single institution. Their data were reviewed retrospectively.ResultsOf all, 831 patients underwent PBD. The mean duration between drainage and surgery was 16.9 days. Regarding postoperative outcomes, length of hospital stay was longer in the drainage group (P = 0.028). Postoperative pancreatic fistula was not significantly different between the non‐drainage and drainage groups (P = 0.162), but major complications occurred more frequently in the drainage group (P = 0.002). Multivariable analysis showed major complications occurred significantly at third and fourth weeks (odds ratios 1.863 and 2.523) after PBD, whereas early surgery performed in the first 2 weeks did not noticeably increase postoperative complications. In multivariable survival comparison, weekly interval beyond 6 weeks was associated with poor survival in those with pancreatic cancer, while patients with bile duct cancer operated on at the fourth week showed worse prognosis.ConclusionsEarly surgery that reduces the operative delay after PBD may improve both short‐ and long‐term postoperative outcomes in cancer patients undergoing PBD.

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Multivariate analysis of factors associated with renal dysfunction in patients with obstructive jaundice

Abstract: Renal dysfunction in patients with obstructive jaundice was associated with the degree of biliary obstruction, age of the patient and reduced urinary sodium excretion. These alterations were closely related to derangements in sodium- and water-regulating hormones.

Cited by 31 publications

References 21 publications

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

The hepatic protective mechanism of Ginkgo biloba extract in rats with obstructive jaundice

Optimal timing of pancreaticoduodenectomy following preoperative biliary drainage considering major morbidity and postoperative survival

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