Efeitos do pneumoperitônio sobre biomarcadores de lesão renal: estudo clínico randomizado
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Data
2020-08-21
Autores
Marton Filho, Marcos Antonio
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Universidade Estadual Paulista (Unesp)
Resumo
Justificativa e objetivo: O aumento da pressão intra-abdominal para a realização de cirurgias laparoscópicas provoca alterações hemodinâmicas com variações da pressão arterial e venosa que modificam a homeostasia renal. Métodos: Este ensaio clínico simples cego, de centro único, randomizou 74 pacientes submetidos a colecistectomia videolaparoscópica, dos quais 64 completaram o estudo. Trinta e três indivíduos foram alocados no grupo de pressão intra-abdominal padrão (P10-12 entre 10 e 12 mmHg) e 31, no grupo de baixa pressão (P6-8 entre 6 e 8 mmHg). Os desfechos primários analisados foram a variação do valor de NGAL (neutrophil gelatinase-associated lipocalin) e da Cistatina-C séricos, mensurados no início do procedimento (M0), no final do procedimento (M1) e 24 horas após o procedimento (M2). Valores de p abaixo de 0,05 foram considerados estatisticamente significantes. Resultados: No grupo P6-8 os valores de NGAL tiveram médias de 60,8 ± 11,1 ng/ml em M0, 148,3 ± 17,8 ng/ml em M1 e 63,9 ± 8,8 ng/ml em M2, enquanto no grupo P10-12 as médias foram de 60,1 ± 11,5 em M0, 157,5 ± 19,8 ng/ml em M1 e 61,2 ± 11,4 ng/ml em M2. Embora não tenha havido uma diferença significativa na evolução do marcador entre os grupos (p=0,580), verificou-se uma diferença significativa entre os momentos nos participantes do estudo com uma elevação notada no momento M1 (p<0,001). Na análise da Cistatina-C, as médias no grupo P6-8 foram de 2184,9 ± 536,0 ng/ml em M0, 2631,6 ± 1092,6 ng/ml em M1 e 2233,9 ± 527,2 ng/ml em M2, enquanto para o grupo P10-12 foram 2428,9 ± 529,8 ng/ml em M0, 2712,2 ± 801,2 ng/ml em M1 e 2496,9 ± 457,0 em M2. Assim como no NGAL, esse marcador mostrou uma elevação no M1 nos dois grupos (p=0,021), mas sem diferença na comparação entre grupos. Conclusão: A colecistectomia videolaparoscópica aumenta os valores de NGAL e Cistatina-C no momento M1 e a implementação de baixas pressões de pneumoperitônio não modifica essa evolução dos marcadores.
Background: Increased intra-abdominal pressure for laparoscopic surgery causes hemodynamic changes with variation in arterial and venous blood pressure affecting renal homeostasis. Methods: This randomized, single-blind, single-center clinical trial selected 74 patients undergoing laparoscopic cholecystectomy, and 64 of them completed the study. Thirty-three patients were allocated to the standard pressure group (P10-12, 10-12 mmHg) and 31 patients were allocated to the low pressure group ((P6-8, 6-8 mm Hg). The primary outcome was the change in serum neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels measured at the beginning of the procedure (T0), at the end of the procedure (T1), and 24 hours after the procedure (T2). P-values < 0.05 were considered statistically significant. Results: In the P6-8 group, mean NGAL values were 60.8 ± 11.1 ng/ml at time point 0 (T0), 148.3 ± 17.8 ng/ml at T1, and 63.9 ± 8.8 ng/ml at T2; in the P10-12 group, mean values were 60.1 ± 11.5 ng/ml at T0, 157.5 ± 19.8 ng/ml at T1, and 61.2 ± 11.4 ng/ml at T2. Although there was no significant difference in the course of the biomarker between the groups (P = 0.580), there was a significant difference between the time points with elevation at T1 (P < 0.001). In the P6-8 group, mean cystatin C values were 2184.9 ± 536.0 ng/ml at T0, 2631.6 ± 1092.6 ng/ml at T1, and 2233.9 ± 527.2 ng/ml at T2; in the P10-12 group, mean values were 2428.9 ± 529.8 ng/ml at T0, 2712.2 ± 801.2 ng/ml at T1, and 2496.9 ± 457.0 at T2. Similar to NGAL, cystatin C had an elevation at T1 in both groups (P = 0.021), but no difference was found when comparing the groups. Conclusions: Laparoscopic cholecystectomy increases NGAL and cystatin C levels at T1, and the use of low pressure pneumoperitoneum does not change the course of the biomarkers.
Background: Increased intra-abdominal pressure for laparoscopic surgery causes hemodynamic changes with variation in arterial and venous blood pressure affecting renal homeostasis. Methods: This randomized, single-blind, single-center clinical trial selected 74 patients undergoing laparoscopic cholecystectomy, and 64 of them completed the study. Thirty-three patients were allocated to the standard pressure group (P10-12, 10-12 mmHg) and 31 patients were allocated to the low pressure group ((P6-8, 6-8 mm Hg). The primary outcome was the change in serum neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels measured at the beginning of the procedure (T0), at the end of the procedure (T1), and 24 hours after the procedure (T2). P-values < 0.05 were considered statistically significant. Results: In the P6-8 group, mean NGAL values were 60.8 ± 11.1 ng/ml at time point 0 (T0), 148.3 ± 17.8 ng/ml at T1, and 63.9 ± 8.8 ng/ml at T2; in the P10-12 group, mean values were 60.1 ± 11.5 ng/ml at T0, 157.5 ± 19.8 ng/ml at T1, and 61.2 ± 11.4 ng/ml at T2. Although there was no significant difference in the course of the biomarker between the groups (P = 0.580), there was a significant difference between the time points with elevation at T1 (P < 0.001). In the P6-8 group, mean cystatin C values were 2184.9 ± 536.0 ng/ml at T0, 2631.6 ± 1092.6 ng/ml at T1, and 2233.9 ± 527.2 ng/ml at T2; in the P10-12 group, mean values were 2428.9 ± 529.8 ng/ml at T0, 2712.2 ± 801.2 ng/ml at T1, and 2496.9 ± 457.0 at T2. Similar to NGAL, cystatin C had an elevation at T1 in both groups (P = 0.021), but no difference was found when comparing the groups. Conclusions: Laparoscopic cholecystectomy increases NGAL and cystatin C levels at T1, and the use of low pressure pneumoperitoneum does not change the course of the biomarkers.
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Palavras-chave
Lipocalina-2, Cistatina C, Biomarcadores, Pneumoperitônio artificial, Lesão renal aguda, Lipocalin-2, Pneumoperitoneum, artificial, Cystatin c, Biomarkers, Acute kidney injury