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The Effect of N-acetyl Cysteine Injection on Liver Function After On-Pump Coronary Artery Bypass Graft Surgery: a Randomized Clinical Trial

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Abstract

Somebody’s organ dysfunctions are associated with the cardiopulmonary bypass in open-heart surgery such as liver dysfunction. This study aimed at the impact of the N-acetyl cysteine for improvement of liver function subsequently on-pump coronary artery bypass graft. Following a clinical trial design, 60 candidates of on-pump CABG, age 30 to 70 years, normal liver function, and normal renal function were selected. The candidates were randomly divided into intervention: IV100 mg/kg N-acetyl cysteine in three doses (2 intraoperative and 1 postoperative) over 24 h, and control groups (normal saline as placebo) (n = 30 in each group). The main outcomes were serum alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, bilirubin, partial thromboplastin time, and the international normalized ratio at first and second postoperative day after surgery. Secondary outcomes were the hemodynamic variables and blood product transfusion. There were significant differences in ALP (P < 0.001), AST (P = 0.02), ALT (P < 0.001), bilirubin (P = 0.01), PTT (P < 0.001), and INR (P = 0.005) levels between the two groups at the first day after surgery. There were significant differences in ALP (P = 0.002), AST (P < 0.001), ALT (P = 0.001), and bilirubin (P = 0.004) levels between the two groups on the second day after surgery. These levels were significantly lower in the N-acetyl cysteine group. Significant differences were observed between the two groups in terms of MAP levels on the first day (P = 0.002) and the second day after surgery (P < 0/001). There was a significant difference between the two groups in terms of packed cell (P = 0.002) and FFP (P < 0.001) transfusion. Based on the findings, intravenous administration of N-acetyl cysteine in patients with CABG significantly may be preserved liver function. Registered under No. Trial registration number IRCT20190506043492N2, date of registration: 2020.05.23. Retrospectively registered.

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Data Availability

All data were received from the institutional database and are available from the corresponding authors upon reasonable request.

Code Availability

SPSS 22.

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Acknowledgements

The current study is a part of a thesis proposal that is approved by the Ethics Committee (IR.AJUMS.REC.1398.391). We followed a placebo-controlled double-blind clinical trial design (IRCT20190506043492N2). The authors sincerely thank all participants who helped the study team.

Funding

The current study was supported by the Ahvaz Jundishapur University of Medical Sciences.

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Authors and Affiliations

  1. Department of Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Fatemeh Javaherforooshzadeh, Pegah Abbasi Hormozi, Reza Akhondzadeh, Alireza Olapour & Seyed Jalal Hashemi

  2. Imam Khomeini Hospital, Azadegan Street, P.O. Box: 6155979939, Ahvaz, Iran

    Fatemeh Javaherforooshzadeh

Authors
  1. Fatemeh Javaherforooshzadeh
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  2. Pegah Abbasi Hormozi
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  3. Reza Akhondzadeh
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  4. Alireza Olapour
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  5. Seyed Jalal Hashemi
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Contributions

F.JZ contributed in concept, study design, and the definition of intellectual content; data were collected by P. Ah; F.JZ drafted the manuscript. A. O provided study materials and patients’ information. R. A and J.H conceived of the study and participated in its design. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fatemeh Javaherforooshzadeh.

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Ethics Approval

The current is a part of a thesis proposal (IR.AJUMS. REC.1398.391) that is approved by the Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. In addition, it is registered as a RCT ( IRCT20190506043492N2).

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Written informed consent signed by all of the patients.

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The authors declare no competing interests.

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Javaherforooshzadeh, F., Abbasi Hormozi, P., Akhondzadeh, R. et al. The Effect of N-acetyl Cysteine Injection on Liver Function After On-Pump Coronary Artery Bypass Graft Surgery: a Randomized Clinical Trial. SN Compr. Clin. Med. 3, 2533–2539 (2021). https://doi.org/10.1007/s42399-021-01074-0

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  • DOI: https://doi.org/10.1007/s42399-021-01074-0

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