Incidence and risk factors of parenteral nutrition-associated liver disease in hospitalized adults: A prospective cohort study

Lakananurak, Narisorn; Tienchai, Kakanan

doi:10.1016/j.clnesp.2019.08.009

Cited by 14 publications

(28 citation statements)

References 21 publications

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“…Em relação à alteração hepática (definida neste estudo como elevação das transaminases após o 3º dia de administração da NP), foi encontrada prevalência de 45% (n=28) dos participantes. Do mesmo modo, Lakananurak e Tienchai 23 evidenciaram prevalência dessa complicação em 59,1% (n=26) dos pacientes recebendo NP. Comumente, ocorre em pacientes pós-operatórios ou críticos devido à lesão hepática hipóxica ou hepatite isquêmica 4 .…”

Section: Discussionunclassified

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

Granjeiro¹,

Borges²,

Fortes³

2020

Braspen J

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Introduction: Parenteral nutrition has become an effective alternative for caloric-protein supply in hospitalized patients. The objective of this study is to evaluate the use, complications and clinical outcomes of patients using parenteral nutrition. Methods: Analytical, quantitative, longitudinal, retrospective study with patients admitted to a public hospital. The variables analyzed were: sex, age, presence of malnutrition, nutritional risk, achievement of nutritional goals, reason for indication, type of access, time of use, present complications and deaths. Results: The sample consisted of 62 patients aged 55.1±17.95 years old. Total parenteral nutrition was found more frequently (61%; n=38) and used within 30 days (74%; n=28). As indicated, the postoperative period was prevalent in 45.2% (n=28) of the cases. Nutritional risk (58.1%, n=36) and malnutrition (40.3%; n=25) were prevalent. Hyperglycemia (50%; n=31) and water retention (48.4%; n=30) were the most frequent complications. The presence of water retention increased the chances of death by 3.75 times (OR=3.75; 95%IC 1.25-11.24; p=0.018). Conclusion: The indication of parenteral nutrition was prevalent in postoperative situations, in patients with nutritional risk and malnutrition. Hyperglycemia was the most observed complication and the presence of water retention associated with a higher risk of mortality when using this therapy.

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Section: Discussionunclassified

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

Granjeiro¹,

Borges²,

Fortes³

2020

Braspen J

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“…Deficiencies in carnitine, choline, or vitamin E can also play a role in the degree of steatosis 1,8,9,11,12 . Malnourished patients with an essential fatty acid deficiency (EFAD) may have increased hepatic triglyceride secretion, resulting in steatosis 1,11 . Steatosis is more common in children and adults and can be diagnosed via mild aminotransferase enzyme elevations, including ALT and AST 9,11,25,27 .…”

Section: Diagnosis Of Ifaldmentioning

confidence: 99%

“…In adults receiving prolonged PN, IFALD can manifest in stages ranging from steatosis to cholestasis to fibrosis and cirrhosis, sometimes requiring a liver transplant in severe cases 1,14 (Figure 1). In a study of acutely ill, malnourished adult patients, 59% of patients developed liver abnormalities, including cholestasis (34%), steatosis (23%), or a mixture of both (2%), after an average of 2 weeks of PN administration, though it was unclear if there was an active infection that could also increase the risk for liver function test abnormalities 1,29 . In contrast, another study reported the reversal of hepatic fibrosis of an adult male receiving PN since birth with a mixed‐oil ILE composed of soy, medium‐chain triglyceride (MCT), olive oil, and fish oil (FO) (Smoflipid, Fresenius Kabi, Uppsala, Sweden) 5 …”

Section: Diagnosis Of Ifaldmentioning

confidence: 99%

“…Parenteral nutrition (PN) is a life‐sustaining, intravenous form of nutrition support for patients with inadequate or impaired bowel function 1,2 . PN is classified as a high‐alert medication, containing >40 ingredients including water, amino acids, glucose, lipids, electrolytes, multivitamins, trace elements, and occasionally medications (eg, insulin) 2–4 .…”

Section: Introductionmentioning

confidence: 99%

“…In adults, the morbidity associated with IFALD is directly correlated with the duration of PN, with 55% of adults developing IFALD in about 2 years, 65% around the 4‐year mark, and 70% after 6 years 16 . However, some researchers have documented evidence of liver abnormalities in as little as 12.5 days, albeit their study population was comprised of acutely ill hospitalized adults 1 . Based on these findings, understanding the mechanisms and potential culprits for IFALD in pediatric and adult patients is vital to reduce the risk for morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Exploring the long‐term risk factors associated with intestinal failure–associated liver disease in pediatric and adult patients: The role of lipid injectable emulsions in the development of liver disease

Meléndez¹,

Yeh

2022

Nut in Clin Prac

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Background: Despite parenteral nutrition (PN) being life sustaining, one of the risk factors associated with its long-term use is intestinal failure-associated liver disease (IFALD), which increases the risk for morbidity and mortality. This review examines some of the risk factors associated with IFALD.Methods: A literature review using the databases PubMed, EMBASE, and CINAHL between 2010 and 2020 was performed using search terms, including long-term total PN and liver failure, serum plant sterols and liver failure, and complications and PN. Articles in English using both human and animal participants were included. Results:The pathophysiology associated with PN and liver disease is multifactorial and influenced by the remaining small-bowel length, presence of the ileal cecal valve, lack of enteral stimulation, type of lipid injectable emulsion (ILE), plant sterol content, and excessive calories. The type of ILE plays a major role because of the phytosterol (PS) content, affecting the microbiome composition and inhibiting key gut signals. The PS content is highest in soy oil (SO)-based ILE, which increases inflammation and impairs biliary flow. Conclusion:Serum PS correlates with liver biomarker abnormalities and is highest in SO-based ILE use compared with mixed-oil emulsions. Selection of a low-PS content ILE is recommended to reduce the risk of biliary cholestasis.Stimulation of the gut, if possible, is recommended to maintain gut integrity and reduce bacterial overgrowth. Fish oil (FO) shows promise in IFALD reversal however, large randomized controlled trials are needed to further establish support for the use of FO in adults.

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Association between congenital heart disease and parenteral nutrition–associated liver disease in neonates: A retrospective cohort study

Santharam

Nitkin

Rajgarhia

et al. 2023

J Parenter Enteral Nutr

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Objective: Infants receiving parenteral nutrition (PN) are at increased risk of PN-associated liver disease (PNALD), which can lead to hepatic fibrosis. Congenital heart disease (CHD) represents a risk factor for hepatic fibrosis, so this study sought to better understand whether infants with CHD were at elevated risk of PNALD when receiving long-term PN.Study Design: This study includes a retrospective cohort of infants at a level IV neonatal intensive care unit from 2010 to 2020 who received long-term PN during the first 8 weeks of life. A time-varying Cox survival model was used to model risk of PNALD between infants with and without CHD, adjusted for demographics, surgical intervention, and PN exposure, using a 5000-iteration bootstrap estimation.Secondary analyses evaluated risk against discrete CHD diagnoses, and sensitivity analysis was performed on the magnitude and quantity of direct bilirubin laboratory measurements making up the PNALD definition.Results: Neonates with CHD were found to be at higher risk for PNALD during or soon after long-term PN exposure. A pattern of increasing association strength with increasing bilirubin threshold suggests infants with CHD may also experience higher degrees of injury.Conclusions: This work offers a step in understanding how diagnoses can be factored into neonate PN prescription. Future work will explore modifications in lipid profiles and timing to mitigate risk in patients with CHD.

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Incidence and risk factors of parenteral nutrition-associated liver disease in hospitalized adults: A prospective cohort study

Cited by 14 publications

References 21 publications

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

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

Exploring the long‐term risk factors associated with intestinal failure–associated liver disease in pediatric and adult patients: The role of lipid injectable emulsions in the development of liver disease

Association between congenital heart disease and parenteral nutrition–associated liver disease in neonates: A retrospective cohort study

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