The impact of N-acetylcysteine and ascorbic acid in contrast-induced nephropathy in critical care patients: an open-label randomized controlled study
Autor: | Epaminondas Zakynthinos, Demosthenes Makris, Grigorios Garoufalis, Eleni Palli, John Papanikolaou, Paris Zygoulis, Irini Tsilioni |
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Jazyk: | angličtina |
Rok vydání: | 2017 |
Předmět: |
Male
Contrast Media 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Kidney Gastroenterology Blood Urea Nitrogen chemistry.chemical_compound 0302 clinical medicine Interquartile range Prospective Studies Greece lcsh:Medical emergencies. Critical care. Intensive care. First aid Acute Kidney Injury Middle Aged Intensive Care Units Creatinine Ascorbic acid Administration Intravenous Female medicine.medical_specialty Critical Care Contrast-induced nephropathy Renal function Statistics Nonparametric Nephrotoxicity Nephropathy 03 medical and health sciences Contrast induced nephropathy Internal medicine Intensive care medicine Humans cystatin-C business.industry Research 030208 emergency & critical care medicine lcsh:RC86-88.9 medicine.disease N-acetylcysteine Surgery Acetylcysteine 8-Isoprostane chemistry ROC Curve Multivariate Analysis business Tomography X-Ray Computed |
Zdroj: | Critical Care, Vol 21, Iss 1, Pp 1-9 (2017) Critical Care |
ISSN: | 1364-8535 |
Popis: | Background The aim was to investigate whether the use of N-acetylcysteine and ascorbic acid reduce contrast-induced nephropathy incidence in critical care patients. Methods This was a one-center, two-arm, prospective, randomized, open-label, controlled trial in the Intensive Care Unit of the University Hospital of Larissa, Greece. Patients with stable renal function, who underwent non urgent contrast-enhanced computed tomography for diagnostic purposes, were included in the study. Patients in the treatment group (NacA, n = 60) received intravenously N-acetylcysteine (1200 mg) and ascorbic acid (2 g) dissolved separately in 100 ml of normal saline 2 hours before, and at 10 hours and 18 hours following the infusion of contrast agent, while control group patients (CG, n = 64) received only normal saline. All patients received additional hydration. Contrast-induced nephropathy was defined as relative increase by 25% of the baseline values of serum creatinine. Results Contrast-induced nephropathy in NacA and CG were 18.33% and 15.6%, respectively (p = 0.81). The percentage change median (interquartile range (IR)) of serum cystatin-C (mg/L) from baseline in patients who underwent contrast-induced tomography, were 37.23% (28.53) and 93.20% (46.90) in NacA and in CG, respectively (p = 0.03). The 8-isoprostane serum levels in NacA were significantly lower compared to CG at 2 hours (p = 0.012) and 24 hours (p = 0.006) following radiocontrast infusion. Multivariate analysis revealed that contrast-induced nephropathy was independently associated with a higher baseline ratio of serum urea/creatinine (odds ratio, 1.02; 95 CI%, 1.00–1.05) and with the use of nephrotoxic medications (odds ratio, 0.24; 95 CI%, 0.06–0.94). Conclusion Intravenous administration of N-acetylcysteine and ascorbic acid failed to reduce contrast-induced nephropathy in critically ill patients who underwent contrast-enhanced computed tomography, despite a significant reduction of 8-isoprostane levels in treated patients. Trial registration ClinicalTrials.gov, NCT01017796. Registered on 20 November 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1862-3) contains supplementary material, which is available to authorized users. |
Databáze: | OpenAIRE |
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