Effect of perioperative glutamine administration on C-reactive protein and liver function tests in patients undergoing hepatic resection
Languages of publication
Hepatic resections are commonly associated with high morbidity and mortality. Nutrition plays an important role in reducing postoperative complications besides improvement in intensive care and perioperative management. The aim of the study was to evaluate the role of glutamine as an immunonutrient in patients undergoing hepatic resection. Material and methods. The study included 22 patients who underwent hepatectomy. Patients were randomized into two equal groups wherein group A patients received perioperative glutamine whereas group B patients served as controls. Primary outcome measures were level of serum albumin, C‑reactive protein (CRP), liver function tests and absolute neutrophil counts in the postoperative period while secondary outcome included post operative complications. Results. Glutamine decreased the CRP response in liver resection in a statistically significant manner (p=0.028) on the fifth post operative day. This may signify that glutamine decreases the post operative inflammatory response associated with liver resection. Glutamine did not have any significant effect on liver function tests. Postoperative morbidity was less in patients who received glutamine. Conclusion. Glutamine successfully blunted the CRP response in patients who received glutamine postoperatively. Decrease in morbidity following glutamine administration is an attractive area of prospective research and requires further consideration involving larger patient groups.
1 - 01 - 2014
27 - 02 - 2014
- 1. Poon RT, Fan ST, Lo CM et al.: Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004; 240: 698-708.
- 2. Fan ST, Lo CM, Lai ECS et al.: Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma N Engl J Med 1994; 331: 1547-52.
- 3. Cerantola Y, Hubner M, Grass F et al.: Immunonutrition in gastrointestinal surgery. Br J Surg 2011; 98: 37-48.[PubMed][WoS][Crossref]
- 4. Richter R, Schmandra T, Golling M, Bechstein W: Nutritional support after open liver resection: a systematic review. Dig Surgery 2006: 23: 139-45.[Crossref]
- 5. Mikagi K, Kawahara R, Kinoshita H, Aoyagi S: Effect of preoperative immunonutrition in patients undergoing hepatectomy; a randomized controlled trial. Kurume Med J 2011; 58: 1-8.[Crossref][PubMed]
- 6. Marik P, Flemmer M: Immunonutrition in the surgical patient. Minerva Anestesiol 2012; 78: 336-42.[PubMed]
- 7. Welbourne TC, Joshi S: Interorgan glutamine metabolism during acidosis. J Parenter Enter Nutr 1990; 14(suppl): 77s.[Crossref]
- 8. Hong RW , Rounds JD, Helton WS : Glutamine preserves liver glutathione after lethal hepatic injury. Ann Surg 1992; 215: 114.
- 9. Hwang TL, O’Dwyer ST, Smith RJ , Wilmore DW: Preservation of small bowel mucosa using GLNenriched parenteral nutrition. Surg Forum 1986; 37: 56.
- 10. Burke D, Alverdy JC , Aoys E, Moss GS: Glutamine supplemented total parenteral nutrition improves gut immune function. Arch Surg 1989; 124: 1396.
- 11. Braga M: Perioperative immunonutrition and gut function. Curr Opin Clin Nutr Metab Care 2012; 15: 485-88.[PubMed][Crossref][WoS]
- 12. Helminen H, Raitanen M, Kellosalo J: ImmunonutrItIon In elective gastrointestinal surgery.Scand J Surg 2007; 96: 46-50.[PubMed]
- 13. Castell JV, Gomes-Lechon MJ, David M et al.: Acute phase response of human hepatocytes: regulation of acute-phase protein synthesis by interleukin-6. Hepatology 1990; 12: 1179-86.[Crossref]
- 14. Gelin J, Moldawer LL, Lönnroch C et al.: Role of endogenous tumor necrosis factor alpha and interleukin-1 for experimental tumor growth and the development of cancer cachexia. Cancer Res 1991; 51: 415.[PubMed]
- 15. de Jong KP, von Geusau BA, Rottier CA et al.: Serum response of hepatocyte growth factor, insulin- like growth factor-I, interleukin-6, and acute phase proteins in patients with colorectal liver metastases treated with partial hepatectomy or cryosurgery. J Hepatol 2001; 34: 422-27.
- 16. Wong VK, Malik HZ , Hamady ZZ et al.: Creactive protein as a predictor of prognosis following curative resection for colorectal liver metastases.Br J Cancer 2007; 96: 222-25.[Crossref]
- 17. Hashimoto K, Ikeda Y, Korenaga D et al.: The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma.Cancer 2005; 103: 1856-64.
- 18. Lima KVG, Maio R: Nutritional status, systemic inflammation and prognosis of patients with gastrointestinal cancer. Nutr Hosp 2012; 27: 707-14.[WoS]
- 19. Shronts EP: Basic concepts of immunology and its application to clinical nutrition. Nutr Clin Pract 1993; 8: 177-83.[PubMed][Crossref]
- 20. Casey J, Flinn WR , Yao JS et al.: Correlation of immune and nutritional status with wound complications in patients undergoing vascular operations. Surgery 1983; 93: 822-27.[PubMed]
- 21. Omran ML, Morley JE : Assessment of protein energy malnutrition in older persons, part II: Laboratory evaluation. Nutrition 2000; 16: 131-40.[Crossref][PubMed]
- 22. Roxburgh CS , Salmond JM, Horgan PG et al.: Comparison of the prognostic value of inflammation based pathologic and biochemical criteria in patients undergoing potentially curative resection for colorectal cancer. Ann Surg 2009; 249: 788-93.
- 23. Qiu Y, Zhu X, Wang W et al.: Nutrition Support With glutamine dipeptide in patients undergoing liver transplantation. Transplant Proc 2009 ; 41, 4232-37.[Crossref][PubMed]
- 24. Forse RA , Rompre C, Crosilla P et al.: Reliability of the total lymphocyte count as a parameter of nutrition. Can J Surg 1985; 28: 216-19. [PubMed]
Publication order reference