Risk Factor of Persistent Hypotension Associated with 5-Aminolevulinic Acid: A Single-Institution Retrospective Study

Area of Science:

• Oncology
• Pharmacology
• Medical Diagnostics

Background:

• 5-Aminolevulinic acid (5-ALA) is utilized in photodynamic diagnosis (PDD) for bladder cancer, inducing fluorescence for tumor visualization.
• Hypotension is a known adverse effect of 5-ALA PDD, with previous research focusing on immediate post-administration events.
• Persistent hypotension, extending beyond the day of 5-ALA administration, necessitates ongoing patient management, yet its risk factors are not well-defined.

Purpose of the Study:

• To identify risk factors associated with persistent hypotension following 5-ALA administration for bladder cancer PDD.
• To investigate the relationship between preoperative clinical characteristics and the development of sustained hypotension post-procedure.

Main Methods:

• A retrospective study analyzed 263 patients undergoing 5-ALA PDD for bladder cancer.
• Patients were categorized into persistent (n=30) and non-persistent (n=153) hypotension groups based on blood pressure the day after administration.
• Multivariate logistic regression and receiver-operating characteristic (ROC) curve analysis were employed to identify risk factors and predict hypotension.

Main Results:

• Preoperative hemoglobin levels were significantly lower in the persistent hypotension group compared to the non-persistent group (p < 0.05).
• Lower preoperative hemoglobin was identified as an independent risk factor for persistent hypotension (OR, 0.76; 95% CI, 0.60-0.97).
• An ROC curve analysis determined a preoperative hemoglobin cutoff value of 12.9 g/dL for predicting persistent hypotension.

Conclusions:

• Preoperative hemoglobin level is a significant independent risk factor for persistent hypotension after 5-ALA PDD in bladder cancer patients.
• A preoperative hemoglobin level below 12.9 g/dL may indicate an increased risk for developing prolonged hypotension.
• These findings suggest that preoperative hemoglobin assessment could aid in stratifying patients at risk for persistent 5-ALA-induced hypotension, guiding postoperative care.