Evaluation of the efficiency of the hepatoprotector glucuronate in toxic hepatitis of various etiology

The objective was to study the effectiveness of the use of hepatoprotector glucuronate at the early stage of intensive therapy of toxic hepatitis of various etiologies.

Materials and methods. We studied 120 patients with toxic hepatitis who were treated at the Republican research center for emergency medicine in 2022–2023. The study was carried out in two groups of patients. Group I – 60 patients admitted in 2023, who, in addition to traditional therapy, received a complex hepatoprotector glucuronate (Jetepar®)*. Group II (comparison group) – 60 patients who applied in 2022 and received only traditional therapy. Biochemical blood parameters were studied upon admission and over time on day 5. The severity of intellectual impairment was assessed using cognitive scales and the Reitan test on days 2 and 5 from the start of treatment.

Results. Upon admission, both groups showed signs of toxic liver damage. In dynamics by the 5th day in patients of group I, there was a decrease in ALT by 63.7%, AST by 66.4%, alkaline phosphatase by 54.2% from the initial values, which was 3.9 and 2.6, 2. 1 lower than in the comparison group. The level of free ammonia in patients of group I on the 5th day decreased by 52%, and lactate by 57% from the initial level, almost to the physiological norm, while in the comparison group (II) only by 24.8% and 38.1%, which was 2.2 and 1.5 times worse than in the main group. Screening of the level of intelligence using two cognitive scales and the Reitan test showed that in patients in the comparison group, cognitive function indicators on the 5th day were 1.4, 1.5 and 1.2 times lower than in the main group.

Conclusion. The use of the hepatoprotector glucuronate improves liver parameters and cognitive functions in patients with toxic hepatitis.

1. Akalaev R. N., Stopnitskiy A. A., Khozhiev Kh. Sh. Acute alcohol poisoning. Issues of pathogenesis, diagnosis and intensive care. Monograph / eds by prof. A. M. Khadzhibaev. Tashkent, 2022, pp. 87–104. (In Russ.)

2. Akalaev R. N., Sharipova V. Kh., Stopnitskшy A. A., Khozhiev Kh. Sh. Neurotropic effects of hepatoprotectors in alcohol poisoning. Obshchaya reanimatologiya, 2019, no. 4, pp. 4–10. (In Russ.) DOI: 10.21292/2078-5658-2020-17-3-32-38.

3. Bezvulyak E. I., Basharin V. A., Epifantsev A. V. Possibilities for the prevention of toxic drug-induced liver damage during cancer chemotherapy. Meditsinskii sovet, 2020, no. 5, pp. 42–49. (In Russ.) DOI: 10.21518/2079-701X-2020-5-42-49

4. Ivanikov I. O., Vinogradova N. N., Krashenkov O. P. et al. Acute liver damage due to chemotherapy and the possibility of their treatment. Dokazatelnaia gastroenterologiia, 2020, vol. 9, no. 4, pp. 7–15. (In Russ.) DOI: 10.17116/dokgastro202090417.

5. Livanov G. A., Shikalova I. A., Lodyagin A. N. et al. Features of pharmacological correction of alcoholic fatty liver in patients with acute ethanol poisoning. Eksperimentalnaya i klinicheskaya gastroenterologiya, 2016, vol. 5, no. 129, pp. 46–47. (In Russ)

6. Mandel A. I., Shushpanova T. V., Bedarev R. I. et al. Cognitive disorders associated with impaired detoxifying function of the liver in patients with alcoholic addiction, new approaches in personalized therapy. Bulletin meditsinskoi nauki, 2023, vol. 4, no. 32, pp. 5–15. (In Russ). DOI: 10.31684/25418475-2023-4-5.

7. Pershko V. A., Khalimov Yu. Sh., Matveev S. Yu., Batryn E. G. Modern approaches to the diagnosis and treatment of severe alcoholic hepatitis. Vestnik Rossiiskoi Voenno-meditsinskoi akademii, 2019, vol. 3, no. 67, pp. 211–216. (In Russ). DOI: 10.17816/brmma623925.

8. Sukhanov D. S., Timofeev E. V., Alekseeva Yu. S. et al. Pharmacological correction of hepatotoxicity induced by anti-tuberculosis drugs. Lechashchii vrach, 2023, vol. 26, no. 2, pp. 40–46. (In Russ.) DOI: 10.51793/OS.2023.26.2.006.

9. Abd-Allah H., Nasr M., Ahmed-Farid O. A. H. et al. Nicotinamide and ascorbic acid nanoparticles against the hepatic insult induced in rats by high fat high fructose diet: A comparative study. Life Sci, 2020, vol. 263, 118540. DOI: 10.1016/j.lfs.2020.118540.

10. Al Saleh A., Shahid M., Farid E. et al. The effect of Ascorbic Acid and nicotinamide on panton-valentine leukocidin cytotoxicity: an ex vivo study. Toxins (Basel), 2023, vol. 15, no. 1, pp. 38. DOI: 10.3390/toxins15010038.

11. Andrade R. J., Chalasani N., Björnsson E. S. et al. Drug-induced liver injury. Nat Rev Dis Primers, 2019, vol. 5, no. 1, pp. 58. DOI: 10.1038/s41572-019-0105-0.

12. Arumugam M. K., Paal M. C., Donohue T. M. Jr. et al. Beneficial effects of betaine: a comprehensive review. Biology (basel), 2021, vol. 10, no. 6, pp. 456. DOI: 10.3390/biology10060456.

13. Balkan J., Öztezcan S., Küçük M. et al. The effect of betaine treatment on triglyceride levels and oxidative stress in the liver of ethanol-treated guinea pigs. Experimental and Toxicologic Pathology, 2004, vol. 55, Is 6, pp. 505–509. ISSN 0940-2993.

14. Björnsson H. K., Björnsson E. S. Drug-induced liver injury: Pathogenesis, epidemiology, clinical features, and practical management. Eur J Intern Med, 2022, vol. 97, pp. 26–31. DOI: 10.1016/j.ejim.2021.10.035.

15. Fu S., Wu D., Jiang W. et al. Molecular biomarkers in drug-induced liver injury: challenges and future perspective. Front Pharmacol, 2020, vol. 10, pp. 1667. DOI: 10.3389/fphar.2019.01667.

16. Mukherjee S. Role of betaine in liver disease-worth revisiting or has the die been cast? World J Gastroenterol, 2020, vol. 26, no. 38, pp. 5745–5748. DOI: 10.3748/wjg.v26.i38.5745.

17. McGill M. R., Jaeschke H. Biomarkers of drug-induced liver injury. Adv Pharmacol, 2019, vol. 85, pp. 221–239. DOI: 10.1016/bs.apha.2019.02.001.

18. Rehman A., Mehta K. J. Betaine in ameliorating alcohol-induced hepatic steatosis. Eur J Nutr, 2022, vol. 61, no. 3, pp. 1167–1176. DOI: 10.1007/s00394-021-02738-2.

19. Rosenblatt R., Brown R. S. Jr. Nonviral or drug-induced etiologies of acute liver failure. Clin Liver Dis, 2018, vol. 22, no. 2, pp. 347–360. DOI: 10.1016/j.cld.2018.01.008.

20. Yao Z. P., Li Y., Liu Y. et al. Relationship between the incidence of non-hepatic hyperammonemia and the prognosis of patients in the intensive care unit. World J Gastroenterol, 2020, vol. 26, no. 45, pp. 7222–7231. DOI: 10.3748/wjg.v26.i45.7222.

21. Vidal-Cevallos P., Chávez-Tapia N. C., Uribe M. Current approaches to hepatic encephalopathy. Ann Hepatol, 2022, vol. 27, no. 6, 100757. DOI: 10.1016/j.aohep.2022.100757.

22. Zaccherini G., Weiss E., Moreau R. Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment. JHEP Rep, 2020, vol. 3, no. 1, pp. 100176. DOI: 10.1016/j.jhepr.2020.100176.