The effect of N-acetylcysteine on total serum anti-oxidant potential and urinary albumin excretion in critically ill patients

Abstract

Our results suggest that NAC had no significant effects on the progress of the TAP and the urinary albumin excretion in our patients, which may suggest that NAC at the given dose has no clinical relevance as an early treatment in the critically ill.

Prophylactic N-acetylcysteine decreases serum CRP but not PCT levels and microalbuminuria following major abdominal surgery. A prospective, randomised, double-blinded, placebo-controlled clinical trial

“…Based on our previous results and others' work, we used M:Cr as a sensitive but non-specific marker of inflammation [10,11]. In both groups, values were higher than the laboratory reference range on admission, but decreased within 6 h. In a previous study we treated a heterogeneous ICU population with NAC and came to a similar conclusion to that of this trial.…”

“…In both groups, values were higher than the laboratory reference range on admission, but decreased within 6 h. In a previous study we treated a heterogeneous ICU population with NAC and came to a similar conclusion to that of this trial. There was no significant difference between NAC-and placebo-treated patients regarding serum total antioxidant potential and M:Cr [10]. Based on these findings it seems that NAC is unable to prevent increased albumin excretion via the kidneys.…”

“…Procalcitonin is an early and sensitive marker of the severity of sepsis, but increased levels have also been reported following surgery and trauma [6,8,9]. Inflammatory conditions are associated with increased urinary albumin loss, termed microalbuminuria (expressed as the urinary albumin:creatinine ratio, M:Cr), which seems to be a sensitive but non-specific marker of inflammation [10,11]. In one of our recent investigations we found elevated PCT, CRP and microalbuminuria (M:Cr) levels within 24 h of oesophagectomy, and PCT was also significantly higher in non-survivors than in survivors [12].…”

The immunological benefit of higher dose N-acetyl cysteine following mechanical ventilation in critically ill patients

“…In other study conducted on piglets, it was observed that NAC has no significant effect on the total GSH level [28]. Another study investigated the effects of NAC (150 mg/kg bolus and then 12 mg/kg/day as continuous infusion for 3–5 days) on total antioxidant potential in 60 critically ill patients [29]. The need for inotropic support and mechanical ventilation and ICU stay did not vary significantly between NAC and placebo group.…”

Nutrition and Oxidants in the Critically Ill Patient

“…Although NAC has been shown to increase the intracellular content of glutathione, it does not influence the total antioxidant potential of the blood and actually may increase production of ROS. 55 In addition, many studies have shown harm or no benefit from NAC. 56 Glutamine and cysteine are glutathione precursors, and the former has been shown to be important in maintaining gut mucosal barrier function.…”