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Preoperative 5-aminolevulinic acid administration for brain tumor surgery is associated with an increase in postoperative liver enzymes: a retrospective cohort study
- Source :
- Acta neurochirurgica. 161(11)
- Publication Year :
- 2019
-
Abstract
- Besides 5-aminolevulinic acid (5-ALA), liver enzyme elevation after brain tumor surgery can be caused by anesthesia and medications. In this retrospective study, we determined whether preoperative 5-ALA administration is associated with postoperative elevation of liver enzymes (PELE) in brain tumor patients and identified predictive factors for PELE in patients treated with 5-ALA. In 179 patients undergoing brain tumor surgery with preoperative normal values of liver enzymes, laboratory data on serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and total bilirubin (T.bil) levels were collected preoperatively and through postoperative day (POD) 45. Ninety-nine PELEs (ALT, 56; AST, 34; ALP, 5; and TB, 4) were observed in 62 (34.6%) patients. Four (4.2%) patients treated with 5-ALA showed grade 3 elevation of transaminases based on the Common Terminology Criteria for Adverse Effects. Preoperative 5-ALA treatment was predictive of PELE (odds ratio [95% confidence interval], 2.30 [1.14–4.67]; P = 0.021). In patients treated with 5-ALA (n = 95), 70 PELEs (ALT, 39; AST, 22; ALP, 5; and TB, 4) were observed in 41 (43.2%) patients and significant predictive factors for PELE were preoperative ALT level (1.10 [1.04–1.17]; P = 0.001) and body mass index (BMI, 1.29 [1.08–1.56]; P = 0.006). In patients treated with 5-ALA, 13 and 36 patients, of 39 patients whose maximum postoperative ALT levels > 40 U/L, showed the normal value of serum ALT on PODs 14 and 45, respectively. Only three patients showed ALT elevation > 40 U/L on PODs 15–45, with a downward trend. The use of 5-ALA for brain tumor surgery in patients with preoperative normal values of liver enzymes was associated with increased transient PELE, but a low incidence of severely elevated liver transaminases levels. When 5-ALA is administered to patients with the upper normal value of preoperative serum ALT and overweight, attention is paid to PELE.
- Subjects :
- Adult
Male
medicine.medical_specialty
Bilirubin
Aspartate transaminase
Gastroenterology
Neurosurgical Procedures
030218 nuclear medicine & medical imaging
Body Mass Index
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Postoperative Complications
Internal medicine
Medicine
Humans
Aspartate Aminotransferases
Adverse effect
Photosensitizing Agents
biology
business.industry
Brain Neoplasms
Retrospective cohort study
Alanine Transaminase
Odds ratio
Aminolevulinic Acid
Middle Aged
Alkaline Phosphatase
chemistry
Alanine transaminase
Liver
biology.protein
Alkaline phosphatase
Surgery
Female
Neurology (clinical)
business
Body mass index
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 09420940
- Volume :
- 161
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Acta neurochirurgica
- Accession number :
- edsair.doi.dedup.....726f46035c85ef366aced8932974ba95