Prevalence, outcome and associated factors of deranged liver function tests in patients on home parenteral nutrition

Luman, W; Shaffer, Jonathan

doi:10.1054/clnu.2002.0554

Cited by 116 publications

(91 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17,[82][83][84][85] The incidence of advanced liver disease (fibrosis or cirrhosis) varies between 0% and 50% of patients in retrospective cohorts on long-term PN, with an associated reported mortality rate of up to 22%. 17,[82][83][84][85] This discrepancy in the incidence in severe liver disease between different patient cohorts may reflect an increased use of parenteral lipid predisposing to higher rates of severe liver disease. 17 Patients with ultra-short bowel (<50 cm) are at greatest risk of severe liver disease, which this may, of course, reflect their greater calorie requirement.…”

Section: Liver Diseasementioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

136

108

View full text Add to dashboard Cite

SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

show abstract

Section: Liver Diseasementioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

136

108

View full text Add to dashboard Cite

show abstract

“…En nuestra serie sólo destacaron alteraciones menores de las enzimas hepáticas, sin hiperbilirrubinemia, como ocurre con frecuencia en los pacientes que utilizan NP [25][26][27] . Creemos que se esto se relaciona al rápido inicio del aporte enteral en nuestros pacientes.…”

Section: Discussionunclassified

Insuficiencia intestinal secundaria a síndrome de intestino corto: resultados de un programa multidisciplinario de rehabilitación intestinal

et al. 2016

View full text Add to dashboard Cite

show abstract

“…It has been reported consistently that around 50% of children on PN for 4-12 weeks have cholestasis [2,6,7], but in adults there is a much wider variation in the frequency of IFALD with around 30-50% having a mild disturbance of liver function tests and between 2% [8] and 30% [9] becoming cholestatic after a median of 6 months of PN. These variations in the incidence and subsequent natural history of IFALD reflect differences in case mix, health care systems, and the management of PN solutions, but it is reasonable to assume that one half of children and a third of adults on PN will develop mild liver disease with the potential to progress if not managed actively (see later in this chapter).…”

Section: Incidence and Prevalencementioning

confidence: 99%

“…In contrast to children, the progression of IFALD was slower with a mortality of 22% for the group as a whole, with a 6-year survival of 84% in the patients aged less than 40 years and 53% 6-year survival for older patients. (See also In the United Kingdom, complicated IFALD in adults is uncommon with only around 2% of long-term PN patients becoming frankly jaundiced [8]. The reason for the difference in frequency of jaundice between different units is unclear but may reflect differences in exposure to intravenous lipid and the availability of Nutritional Support Teams.…”

Section: Clinicalmentioning

confidence: 99%

Intestinal Failure‐Associated Liver Disease

Beath

Woodward

2008

Intestinal Failure

View full text Add to dashboard Cite

Key pointsr Intestinal failure-associated liver disease (IFALD) is defined as a persistent (more than 2 weeks) elevation of liver function tests 1.5 times above the normal reference range. r 50% of children and 30% adults have evidence of mild IFALD after 4-12 weeks of parenteral nutrition (PN). r IFALD in children typically presents as cholestasis, whereas in adults steatosis is the usual underlying histopathology.r Early detection of IFALD should prompt multiprofessional review of the PN prescription, dietetic advice regarding enteral feeding, screening for infection and co-morbidity and focus efforts to achieve early discharge from hospital. r Undernutrition, which normally defines severe liver disease, is masked by PN, frequently leading to an underestimation of IFALD severity. r Persistent jaundice is a manifestation of advanced liver disease in the context of IFALD. r When decompensation of IFALD occurs, it is often very rapid and accounts for the high mortality rate of patients awaiting liver and bowel transplants.

show abstract

Prevalence, outcome and associated factors of deranged liver function tests in patients on home parenteral nutrition

Cited by 116 publications

References 23 publications

Review article: the management of long‐term parenteral nutrition

Review article: the management of long‐term parenteral nutrition

Insuficiencia intestinal secundaria a síndrome de intestino corto: resultados de un programa multidisciplinario de rehabilitación intestinal

Intestinal Failure‐Associated Liver Disease

Contact Info

Product

Resources

About