Correlation of Plasma Kynurenic Acid Level with the Severity of Depression, Pain, And the Need of Opioids for Pain Management in Cancer Patients in Palliative Care Unit in Dr. Soetomo General Hospital Surabaya

Rizky Iman Kurniawan¹, Arie Utariani^2*, Dedi Susila²

Abstract

Introduction: Most cancer cases in Indonesia are diagnosed at an advanced stage, and the cure rate and life expectancy are not as expected. Depression and pain are the most common problems that arise in cancer patients. Kynurenic acid and quinolinic acid are neuroactive metabolites produced in the kynurenine pathway. Decreased kynurenic acid levels have been reported to be associated with depression, pain, and pathology in cancer.

Objective: This study aims to determine the correlation between kynurenic acid levels and the severity of depression, pain level, and opioid need in cancer patients undergoing palliative treatment.

Material and Method: This study was an observational analytic study with a retrospective cohort design. The study population was adult patients with malignancy in the palliative care unit of Dr. Soetomo General Hospital Surabaya that received opioid treatment during the study period. The sample of this study was 54 patients. Plasma kynurenic acid levels were measured using the ‘Human Kynurenic acid ELISA kit’ from BT Lab. The severity of depression was measured by the Hamilton Depression Rating Scale (HDRS). Pain level was scored with Pain Numeric Rating Scale (NRS), while the opioid use was collected from the patient’s medical record.

Result and Discussion: There was a significant relationship between kynurenic acid levels and the severity of depression (p<0.001), pain level (p<0,001), and opioid need (p=0,007). Simple linear regression analysis showed that the lower the kynurenic acid level, the more severe the depression (p<0.001) and the higher the opioid dose needed (p=0,004). Moderate pain has a lower median kynurenic acid level than mild pain, 12.32 nmol/L, and 16.29 nmol/L, respectively. Patients with a lower level of kynurenic acid require a higher dose of the same type of opioid.

Conclusion: The lower level of plasma kynurenic acid is associated with more severe depression, more pain level, and more opioid need for pain management in malignancy patients in the palliative care unit of Dr. Soetomo General Hospital Surabaya.

Keywords

kynurenic acid; depression; pain; opioid; malignancy; palliative care

Cite This Article

Kurniawan, R. I., Utariani, A., Susila, D. (2021). Correlation of Plasma Kynurenic Acid Level with the Severity of Depression, Pain, And the Need of Opioids for Pain Management in Cancer Patients in Palliative Care Unit in Dr. Soetomo General Hospital Surabaya. International Journal of Scientific Advances (IJSCIA), Volume 2| Issue 5: Sep-Oct 2021, Pages 917-924 , URL: https://www.ijscia.com/wp-content/uploads/2021/10/Volume2-Issue5-Sep-Oct-No.188-917-924.pdf

Volume 2 | Issue 5: Sep-Oct 2021