Effect of alpha-lipoic acid on acute lung injury and acute kidney injury in major postpartum hemorrhage

Introduction Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Resuscitated hemorrhagic shock patients are susceptible to the development of a systemic inflammatory response and organ dysfunction. This study aimed to investigate the effects of alpha-lipoic acid (ALA) as an adjunctive therapy that protects against the occurrence of acute lung injury (ALI) and acute kidney injury (AKI) in patients with major PPH. Patients and methods Forty patients admitted to Ain Shams Obstetric ICU with major PPH were randomly allocated into two equal groups: the ALA group received intravenous 1200 mg ALA once daily for 3 days and the placebo group received 500 ml of 0.9% isotone saline solution over 60 min once daily for 3 days. The primary study outcome was the serum levels of thiobarbituric acid reactive species as a marker of oxidative damage and interleukin-6 as a marker of inflammatory response. The secondary outcomes were the incidence of ALI and AKI. Results ALA attenuated the oxidative damage and the inflammatory response as evidenced by the reduction in both thiobarbituric acid reactive species and interleukin-6 levels, respectively (P < 0.001). AKI developed in 5% of patients in the ALA group versus 25% of patients in the placebo group 48 h after ICU admission. The oxygenation index (PaO 2 /FiO 2 ) reached less than 300 in 10% of patients in the ALA group and in 30% of patients in the placebo group. Conclusion ALA decreases markers of oxidative stress and inflammatory response and also has a preventive effect on the progression of ALI and AKI in patients with major PPH.