Lipid-Free Parenteral Nutrition Is Associated with an Increased Risk of Hepatic Dysfunction in Surgical Critically Ill Patients: A Retrospective Observational Study

Abstract

To evaluate the effects of lipid-free parenteral nutrition (PN) and various intravenous fat emulsions (IVFEs) on hepatic function in surgical critically ill trauma/acute care surgery patients. We retrospectively reviewed trauma/acute care surgery patients without admission hepatic disorder that received PN. The PN groups include lipid-free, soybean oil/medium-chain triglyceride, olive oil-based, and fish-oil contained PN. We excluded patients with (1) age <18 years, (2) without surgery, (3) preexisting liver injury/diseases, (4) hyperbilirubinemia at admission, (5) received more than one type of PN, and (6) repeated ICU episodes in the same hospitalization. Hepatic dysfunction was considered as serum total–bilirubin >6.0 mg/dL. The demographics, severity score, comorbidities, blood stream infection, and mortality were collected for analyses. The major outcome is hepatic function. We also performed analyses stratified by separated lipid doses (g/kg/day). A total of 249 patients were enrolled. There were no demographic differences among groups. The lipid-free PN group had a higher incidence of hepatic dysfunction and mortality. Compared to the lipid-free group, the other three IVFEs had significantly lower risks of hepatic dysfunction, while the olive oil-based group had a significantly lower risk of 30 and 90-day mortality. After being stratified by separating lipid doses, the soybean oils showed a decreasing trend of hepatic dysfunction and mortality with increased dosage. Fish oil >0.05 g/kg/day was associated with lower hepatic dysfunction incidences. Our findings suggest that, when compared to IVFEs, surgical critically ill patients with trauma/acute care surgery that received lipid-free PN are associated with an increased risk of hepatic dysfunction. In addition, the olive oil-based group had a significantly lower risk of mortality, while fish oil >0.05 g/kg/day was associated with lower incidences of hepatic dysfunction; however, further studies are warranted.

Activity of aminotransferases as a marker of liver injury in home parenteral nutrition patients

“…Compared to the lipid-free group, the olive oil group had a lower risk of hyperbilirubinemia. In addition, the olive oil group had a significantly lower risk of mortality, while fish oil > 0.05 g/kg/day was associated with a lower incidence of liver dysfunction [13,14].…”

Hepatic dysfunction in patients receiving intravenous lipid emulsions

“…A recent study from China in critically ill surgical patients examined clinical outcomes with three different ILEs: a 50:50 soybean oil (SO)/medium chain TG (MCT) mixture, an 80:20 olive oil (OO)/SO mixture, and a 4-oil 30:30:25:15 SO:MCT:OO:fish oil (FO) mixture (SMOF lipid, or SMOF) compared to fat-free PN. The patients who received fat-free PN had higher rates of hepatic dysfunction (defined in this study as bilirubin >6 mg/dl) and greater mortality at 4 months than those who received ILEs [3]. Importantly, those who were given fat-free PN in this study received the same relative energy supply as the patients who received ILEs.…”

The role of omega-3 polyunsaturated fatty acids in the intensive care unit

“…Patients receiving lipid-free PN had the highest incidence of hepatic dysfunction. Including fish oil, a source of omega-3 PUFAs, at >0.05 g/kg body weight per day was associated with lower incidence of hepatic dysfunction [65].…”

“…Liver function markers are less disturbed in critically ill patients receiving omega-3 PUFAs compared with controls according to a meta-analysis [64]. A recent study evaluated lipid-free PN and PN including one of three different lipid blends on liver function in postsurgical critically ill patients [65]. Patients receiving lipid-free PN had the highest incidence of hepatic dysfunction.…”