EFFECT OF PREOPERATIVE GABAPENTIN ON SERUM NGAL RESPONSES AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: A SECONDARY ANALYSIS OF A RANDOMIZED TRIAL
Kholoud Salah Ibrahim Amin*, Sahar Kamal Tawfeek Hegazy, Hosam Mohamed Mostafa Elghadban, Ahmed Mohammed Hassan Shata
ABSTRACT
Background: Early postoperative renal stress remains a concern after laparoscopic sleeve gastrectomy (LSG), particularly in patients with severe obesity. Serum neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker of renal tubular stress, but the effect of perioperative gabapentin on its postoperative response remains unclear. Methods: This prespecified secondary biomarker analysis included 90 adults with morbid obesity. Thirty non-operative participants formed an external reference cohort (Group I), while 60 undergoing LSG were randomized to surgery without gabapentin (Group II) or after a single preoperative 1200-mg oral dose (Group III). Serum NGAL was measured at baseline, 24 hours, and 6 months in the randomized groups. The primary analysis compared 24-hour NGAL between randomized groups after baseline adjustment. Results: At 24 hours, serum NGAL was significantly lower in Group III than Group II (adjusted ratio, 0.542; 95% CI, 0.500–0.588; P < 0.0001), corresponding to an approximately 45.8% lower adjusted level. Exploratory comparison showed higher NGAL in Group II than in Group I, whereas Group III did not differ significantly from Group I. Postoperative acute kidney injury (PO-AKI). occurred in 2/30 participants in Group III versus 9/30 in Group II (P = 0.0419). Serum NGAL showed good concurrent discrimination for PO-AKI (AUC, 0.874; 95% CI, 0.763–0.945). No significant between-group NGAL difference was observed at 6 months. Conclusion: A single preoperative gabapentin dose (1200 mg) was associated with an attenuated 24-hour serum NGAL response and lower PO-AKI incidence after LSG. Larger randomized studies are needed to confirm these findings.
Keywords: Gabapentin; Neutrophil gelatinase-associated lipocalin (NGAL); Acute kidney injury; Laparoscopic sleeve gastrectomy.
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