Lipid-Free PN is Associated with an Increased Risk of Hyperbilirubinemia in Surgical Critically Ill Patients with Admission Hepatic Disorder: A Retrospective Observational Study

Abstract

Background To evaluate the effect of different PN types on surgical critically ill trauma/acute care surgery patients with hepatic disorders at admission. Methods This is a retrospective study. The PN types included lipid-free, soybean oil/medium-chain triglyceride, olive oil-based, and fish oil-containing PNs. Patients admitted with liver injury or liver surgery, elevated serum AST/ALT level, and elevated serum total bilirubin level were included. The exclusion criteria are as follows: 1) age <18 years, 2) severe liver disease/cirrhosis, 3) received more than one type of PN and 4) serum total bilirubin >4.9 mg/dl at admission. Demographics, severity, comorbidities, blood stream infection, hyperbilirubinemia (total bilirubin > 6.0 mg/dl), and mortality were collected for analysis. We also performed analysis stratified by separated lipid doses (g/kg/day). Results A total of 156 patients were enrolled. There were no demographic differences among groups. The lipid-free group was associated with the highest mortality rate and incidence of hyperbilirubinemia. Compared to the lipid-free group, the olive oil-based group had the lowest risk of hyperbilirubinemia. After being stratified by separated lipid doses, the incidence of hyperbilirubinemia decreased when the lipid dosage increased. Regarding different types of lipids, patients who received more than the median dosage of lipids showed a significantly lower risk of hyperbilirubinemia, except in the fish oil-containing group. Conclusion Our result suggested that lipid-free PN is associated with an increased risk of hyperbilirubinemia in surgical critically ill patients with admission hepatic disorder. 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].…”

“…Cholestasis is the result of obstruction of the bile ducts or inappropriate secretion. It is manifested by an increase in the levels of alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGTP) and bilirubin [14,17]. The degree and severity of liver dysfunction can be classified based on organ features observed on radiological examinationultrasonography (USG), liver imaging with computed tomography, magnetic resonance imaging (MRI) and liver biopsy, which is the gold standard [17].…”

Injectable Lipid Emulsion and Clinical Outcomes in Patients Exclusively Receiving Parenteral Nutrition in an ICU: A Retrospective Cohort Study Using a Japanese Medical Claims Database

“…A meta-analysis of studies between 1980 and 1996, before the strategy of permissive underfeeding gained traction, involved critically ill patients and suggested that those receiving PN without ILE had lower complication rates and equivalent mortality rates compared to those receiving PN with ILE [ 7 ]. On the other hand, a single-center study published in 2021 of a selected group of critically ill surgical patients with hepatic disorder reported the highest mortality rates for those treated with PN without lipids [ 8 ]. In addition, propofol, an anesthetic agent containing lipid as a solvent [ 9 ], is often used during mechanical ventilation, but, to our knowledge, there have been no studies of the effects of ILE on clinical outcomes in critically ill patients that have taken propofol into consideration.…”