Risk factors of hepatic function alterations in hospitalized adult patients treated with short-term parenteral nutrition receiving the same lipid composition at the same dose

Abstract

BackgroundHigh doses and vegetable origin of lipid emulsions (LE) are prominent factors for liver test (LT) alterations in patients treated with parenteral nutrition (PN). This study aims to determine incidence of LT alterations, and risk factors related to these alterations in patients with short term PN with homogenous LE.MethodsAdult non-critically ill hospitalized patients, with normal LTs at the beginning of PN, receiving 0.8 g/kg/day of an olive/soybean LE were included. A paired Student t-test was applied to compare final with initial LT values. LT variation (end vs start of PN) according to type of surgery and infection was studied by means of an analysis of the variance. Univariate and multivariate analyses were constructed to relate the variations of each of the 4 LTs with the adjustment variables.ResultsOne hundred eighty one patients (66.57 ± 12.89 years; 72.4% men), 66.8% suffered from cancer. Final LT values increased from initial values for gamma-glutamyltransferase (GGT) 2.69 ± 2.49 μkat/L vs 0.55 ± 0.36 μkat/L, alkaline phosphatase (AP) 1.97 ± 1.49 μkat/L vs 1.04 ± 0.33 μkat/L, and alanine aminotransferase (ALT) 0.57 ± 0.92 μkat/L vs 0.32 ± 0.26 μkat/L. GGT and AP variations were associated with days of PN; GGT, AP and total bilirubin with surgical patients, AP variations with infection, and GGT with cancer. Multivariate analysis: elevation of GGT, AP and ALT was related to infection, days of PN and surgery.ConclusionsFactors that increased the risk of LTs elevation during short term PN treatment were duration of PN, surgery, cancer, and infection associated with oxidative stress.

Inflammatory processes involved in the alteration of liver function biomarkers in adult hospitalized patients treated with parenteral nutrition

“…In the present work, high GGT and AP values were found, whereas, in a previous study (5) performed in adult patients with Home Parenteral Nutrition (HPN) and, therefore, with elevated plasma PS concentrations, we found much higher ALT and BI values, with no differences in GGT and AP. This could be explained by the fact that increases in GGT and AP emerge as early indicators of hepatic dysfunction, while ALT and BI are linked to hepatocellular damage (11). BI is associated with intrahepatic cholestasis (17, 18) and 15 days of NP treatment are insufficient to appreciate any alteration in BI values.…”

“…In the acute critical patient, there are different risk factors such as surgery, cancer and infection-associated oxidative stress, which promote LFB elevation as well as the inflammatory response (1,10,11). In addition, in septic patients, liver injury can also be explained by the absorption of bacterial lipopolysaccharides (LPS) from the inflamed intestine (12).…”

Complicações e desfechos clínicos de pacientes em uso de nutrição parenteral em um hospital público do Distrito Federal

“…Comumente, ocorre em pacientes pós-operatórios ou críticos devido à lesão hepática hipóxica ou hepatite isquêmica 4 . Llop-Talaveron et al 24 verificaram que, após 8 dias de administração de NP, em 181 pacientes, houve também disfunção hepática por elevação das transaminases.…”

“…O aumento anormal de líquido extracelular geralmente ocorre em pacientes com insuficiência renal ou em administração de doses excessivas de NP ou pela hidratação venosa 4 . Pacientes com doenças cardíacas e hepáticas, concomitantemente, também podem influenciar no aumento de líquido extracelular, ocasionando sintomas, como taquipneia, ganho agudo de peso e hipoalbuminemia 24 .…”

Parenteral Nutrition Overview

“…Here, the cycling of TPN, given the periods of fasting, has been postulated to help with fat mobilization and reduction of hepatic steatosis [ 28 , 105 ]. The use of new generation IVFEs with a lower content of soybean oil, as well as the use of IVFEs containing fish oil, are proven preventive options [ 29 , 84 , 106 , 107 ]. Since sepsis and infection have been related to liver impairment, the prevention and management of infection is also recommended.…”