Cohort Multicenter Study on the Role of Medications in Parenteral Nutrition–Related Alteration of Liver Function Tests in Adults

Abstract

Background Our objective was to assess in non–critically‐ill adult inpatients receiving parenteral nutrition (PN) the risk of developing liver function test (LFT) alterations when receiving concomitant possibly hepatotoxic medications or others reported to improve LFTs during PN. Methods A multicenter retrospective analysis of prospectively collected data was performed on patients receiving PN. Two groups were recruited: group LALT (patients with any LFT alterations during PN), and group NOLALT (patients without such alterations). Exclusion criteria were previous sepsis, shock, renal failure, hyperglycemia, LFT alteration, or biliopancreatic surgical procedures. Medications were classified into 2 categories: medications reported to improve LFTs during PN (n = 8) and possibly hepatotoxic medications (n = 54), including a subgroup of possibly highly hepatotoxic medications (n = 30). Results The study included 200 patients, 136 (68.0%) in the LALT group. The groups differed in the number of patients requiring surgical intervention ≤7 days before PN (LALT, 94 [69.1%]; NOLALT, 29 [45.3%]; P < .002) and those receiving possibly hepatotoxic medications (LALT, 126 [92.6%]; NOLALT, 45 [70.3%]; P < .001). Variables in the final Cox regression model were possibly hepatotoxic medications, odds ratio (OR) 3.310 (1.678–6.530); surgical intervention prior to PN, OR 1.861 (1.277–2.711); baseline triglyceridemia, OR 1.005 (1.001–1.009); and creatinine, OR 1.861 (1.043–3.323). Conclusions Patients who received PN and concomitantly possibly hepatotoxic medications had a 3‐fold risk of developing LFT alterations. Medications reported to improve LFTs had no effect. The use of possibly hepatotoxic medications during PN was associated with LFT alterations.

Parenteral Nutrition Overview

“…Some factors associated with its development are related to the nutrient composition of the PN admixture, whereas others are unrelated to PN use. The basal clinical state (liver or biliary disease, abdominal surgery and sepsis), numerous invasive procedures, infections and liver-insulting drugs may also be present with PN therapy and contribute to alterations in liver tests [ 8 , 103 , 104 ]. Abnormal liver tests are also seen in postoperative or critically ill patients who receive PN, frequently due to hypoxic liver injury or ischemic hepatitis.…”