Factors Predicting Nutritional Derangements in Patients with Obstructive Jaundice: Multivariate Analysis

Abstract

Patients with obstructive jaundice (OJ) that requires surgery often have malnutrition associated with increased perioperative morbidity. This study investigated the factors influencing nutritional derangements in these patients. A series of 46 OJ patients were investigated prospectively (28 malignant tumors, 18 benign obstructions). A nutritional risk index of < 83.5 was used to define protein-calorie malnutrition. Liver function, cholecystokinin (CCK), tumor necrosis factor-alpha (TNFalpha), and endotoxin levels were determined. A multivariate analysis was performed, and an obstructive jaundice malnutrition index (OJMI) was obtained. Altogether, 22 (48%) OJ patients had malnutrition (33% with benign obstructions, 57% with malignant disease). Malnourished patients had higher serum bilirubin levels (258 +/- 120 vs. 154 +/- 62 mmol/L; p = 0.005), longer duration of jaundice (16 +/- 9 vs. 9 +/- 5 days; p = 0.03), and higher plasma levels of CCK (4.0 +/- 1.3 vs. 1.7 +/- 1.0 pmol/L; p = 0.005), alanine aminotransferase (ALT) (226 +/- 209 vs. 187 +/- 161 UI/L; p = 0.01), endotoxin (15 +/- 10 vs. 6.5 +/- 7.0 EU/L; p = 0.007), and TNFalpha (69 +/- 82 vs. 23 +/- 15 pg/ml; p = 0.008) than those without malnutrition. However, only serum bilirubin, CCK, ALT, and patient age were predictors for malnutrition by multivariate analysis. Malnutrition might be expected (95% confidence interval) in patients older than 68 years with increased bilirubin (> 290 mmol/L) and ALT (> 210 UI/L) levels that corresponded with an OJMI > 55. It was concluded that nutritional alterations in patients with obstructive jaundice were determined by the intensity of the biliary obstruction correlated with increased plasma CCK levels as well as with liver dysfunction and patient age.

1H and 31P NMR studies indicate reduced bile constituents in patients with biliary obstruction and infection

“…Moreover, patients with severe jaundice and cholangitis were more hypoproteinaemic than those with mild disease ( Table 2). It has been reported that the severity of hypoproteinaemia seems to be associated with the intensity and duration of the jaundice and cholangitis (45). Biliary obstruction usually leads to moderate impairment of liver anabolic functions.…”

Multivariate analysis of factors associated with renal dysfunction in patients with obstructive jaundice

“…ECW depletion in patients with biliary tract obstruction appears to be the final result of two antagonistic phenomena: negative water and sodium balances owing to inappropriate natriuresis and hypodipsia (probably mediated by increased ANP levels) on one hand, and a relative extracellular fluid expansion due to the effects of hypoalbuminaemia and weight loss on the other16.…”

Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art

“…Malnourishment is commonly seen in patients with an underlying illness such as cancer, or chronic organ failure [3,21,22,23,24,25,26,27,28]. For many years Albumin was of great interest for surgeons as an indicator of malnutrition.…”