Advanced liver function assessment in patients with intestinal failure on long-term parenteral nutrition

Blüthner, Elisabeth; Bednarsch, Jan; Pape, Ulrich‐Frank; Karber, Mirjam; Maasberg, Sebastian; Gerlach, Undine; Pascher, Andreas; Wiedenmann, Bertram; Pratschke, Johann; Stockmann, Martin

doi:10.1016/j.clnu.2019.02.039

Cited by 8 publications

(5 citation statements)

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“…Previously published data from our group suggests that the LiMAx test may be a reliable non-invasive method for detecting hepatic dysfunction in IF patients [8]. The LiMAx test has been successfully evaluated as a new diagnostic test in various clinical scenarios.…”

Section: Discussionmentioning

confidence: 99%

“…Our group has previously evaluated the capability of the 13 C-based breath test LiMAx (Liver Maximum Capacity) in diagnosing IFALD in a large cross-sectional cohort receiving long-term PN [8]. In the present study, we aim to expand this previous research by comparing the effectiveness of non-invasive liver function tests with standard liver function tests for examining liver function and detecting hepatic dysfunction over time in patients receiving PN.…”

Section: Introductionmentioning

confidence: 99%

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Assessing Non-Invasive Liver Function in Patients with Intestinal Failure Receiving Total Parenteral Nutrition—Results from the Prospective PNLiver Trial

et al. 2020

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Liver abnormalities in intestinal failure (IF) patients receiving parenteral nutrition (PN) can progress undetected by standard laboratory tests to intestinal failure associated liver disease (IFALD). The aim of this longitudinal study is to evaluate the ability of non-invasive liver function tests to assess liver function following the initiation of PN. Twenty adult patients with IF were prospectively included at PN initiation and received scheduled follow-up assessments after 6, 12, and 24 months between 2014 and 2019. Each visit included liver assessment (LiMAx [Liver Maximum Capacity] test, ICG [indocyanine green] test, FibroScan), laboratory tests (standard laboratory test, NAFLD [non-alcoholic fatty liver disease] score, FIB–4 [fibrosis-4] score), nutritional status (bioelectrical impedance analysis, indirect calorimetry), and quality of life assessment. The patients were categorized post-hoc based on their continuous need for PN into a reduced parenteral nutrition (RPN) group and a stable parenteral nutrition (SPN) group. While the SPN group (n = 9) had significantly shorter small bowel length and poorer nutritional status at baseline compared to the RPN group (n = 11), no difference in liver function was observed between the distinct groups. Over time, liver function determined by LiMAx did continuously decrease from baseline to 24 months in the SPN group but remained stable in the RPN group. This decrease in liver function assessed with LiMAx in the SPN group preceded deterioration of all other investigated liver function tests during the study period. Our results suggest that the liver function over time is primarily determined by the degree of intestinal failure. Furthermore, the LiMAx test appeared more sensitive in detecting early changes in liver function in comparison to other liver function tests.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessing Non-Invasive Liver Function in Patients with Intestinal Failure Receiving Total Parenteral Nutrition—Results from the Prospective PNLiver Trial

et al. 2020

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“…A number of noninvasive markers of liver fibrosis and steatosis, including FibroScan, LiMAx, and magnetic resonance spectroscopy, have been explored and correlated with cholestasis or traditional risk factors for the development of IFALD. However, none of the noninvasive markers has been incorporated into the definition of IFALD.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Fibrosis in Intestinal Failure–Associated Liver Disease in the Sustain Registry

Wang

Wamuo

Micic

2020

J Parenter Enteral Nutr

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Background Intestinal failure–associated liver disease (IFALD) is one of the leading complications in type III intestinal failure (IF). Early recognition of liver‐fibrosis development in IFALD is crucial to the development of strategies aimed at reducing the risk of complications secondary to IFALD. Our aim was to identify patients with advanced fibrosis using a noninvasive index and to study the risk factors for fibrosis development in the Sustain registry. Methods Using the Sustain registry, patients requiring >3 months of parenteral nutrition (PN) support were identified. The presence or absence of advanced fibrosis was identified using the Fibrosis‐4 (FIB‐4) index. Risk factors for the presence of a high FIB‐4 score were identified using univariable logistic regression. Results Two hundred seventy‐one adult patients were included. Sixty‐three patients (23.2%) were at risk for advanced fibrosis based on the FIB4‐index. Risk factors for advanced fibrosis included short‐bowel syndrome (odds ratios [ORs]: 1.84; 95% confidence interval [CI], 1.03–3.28), receipt of PN for >1 year (OR: 2.6; 95% CI, 1.46–4.64), receipt of PN for >5 years (OR: 3.05; 95% CI, 1.67–5.59), and days of lipid emulsion use (OR: 1.11; 95% CI, 1–1.24). Small‐intestine–remnant length was inversely associated with advanced fibrosis (OR: 0.97, 95% CI, 0.95–0.99). Conclusion Advanced fibrosis, as guided by FIB‐4 index, is associated with known risk factors for IFALD. Therefore, the FIB‐4 index is potentially a useful noninvasive tool for identification of individuals at risk for fibrosis in IFALD. Further studies utilizing a gold‐standard fibrosis assessment will be required to validate these results.

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“…Furthermore, LiMAx has been applied to follow restoration of functional capacity after partial liver resection (Lock et al, 2012 ; Bednarsch et al, 2016 ). The prediction of future liver remnant function via LiMAx highly correlated with future liver volume, and can thus be used to estimate postoperative morbidity (Blüthner et al, 2020 ).…”

Section: Clinical and Experimental Partmentioning

confidence: 99%

Hepatectomy-Induced Alterations in Hepatic Perfusion and Function - Toward Multi-Scale Computational Modeling for a Better Prediction of Post-hepatectomy Liver Function

et al. 2021

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Liver resection causes marked perfusion alterations in the liver remnant both on the organ scale (vascular anatomy) and on the microscale (sinusoidal blood flow on tissue level). These changes in perfusion affect hepatic functions via direct alterations in blood supply and drainage, followed by indirect changes of biomechanical tissue properties and cellular function. Changes in blood flow impose compression, tension and shear forces on the liver tissue. These forces are perceived by mechanosensors on parenchymal and non-parenchymal cells of the liver and regulate cell-cell and cell-matrix interactions as well as cellular signaling and metabolism. These interactions are key players in tissue growth and remodeling, a prerequisite to restore tissue function after PHx. Their dysregulation is associated with metabolic impairment of the liver eventually leading to liver failure, a serious post-hepatectomy complication with high morbidity and mortality. Though certain links are known, the overall functional change after liver surgery is not understood due to complex feedback loops, non-linearities, spatial heterogeneities and different time-scales of events. Computational modeling is a unique approach to gain a better understanding of complex biomedical systems. This approach allows (i) integration of heterogeneous data and knowledge on multiple scales into a consistent view of how perfusion is related to hepatic function; (ii) testing and generating hypotheses based on predictive models, which must be validated experimentally and clinically. In the long term, computational modeling will (iii) support surgical planning by predicting surgery-induced perfusion perturbations and their functional (metabolic) consequences; and thereby (iv) allow minimizing surgical risks for the individual patient. Here, we review the alterations of hepatic perfusion, biomechanical properties and function associated with hepatectomy. Specifically, we provide an overview over the clinical problem, preoperative diagnostics, functional imaging approaches, experimental approaches in animal models, mechanoperception in the liver and impact on cellular metabolism, omics approaches with a focus on transcriptomics, data integration and uncertainty analysis, and computational modeling on multiple scales. Finally, we provide a perspective on how multi-scale computational models, which couple perfusion changes to hepatic function, could become part of clinical workflows to predict and optimize patient outcome after complex liver surgery.

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Advanced liver function assessment in patients with intestinal failure on long-term parenteral nutrition

Cited by 8 publications

References 48 publications

Assessing Non-Invasive Liver Function in Patients with Intestinal Failure Receiving Total Parenteral Nutrition—Results from the Prospective PNLiver Trial

Assessing Non-Invasive Liver Function in Patients with Intestinal Failure Receiving Total Parenteral Nutrition—Results from the Prospective PNLiver Trial

Evaluation of Fibrosis in Intestinal Failure–Associated Liver Disease in the Sustain Registry

Hepatectomy-Induced Alterations in Hepatic Perfusion and Function - Toward Multi-Scale Computational Modeling for a Better Prediction of Post-hepatectomy Liver Function

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