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Critical Care
Published in: Critical Care 1/2007

Open Access 01-02-2007 | Research

Liver dysfunction associated with artificial nutrition in critically ill patients

Authors: Teodoro Grau, Alfonso Bonet, Mercedes Rubio, Dolores Mateo, Mercé Farré, José Antonio Acosta, Antonio Blesa, Juan Carlos Montejo, Abelardo García de Lorenzo, Alfonso Mesejo, the Working Group on Nutrition and Metabolism of the Spanish Society of Critical Care

Published in: Critical Care | Issue 1/2007

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Abstract

Introduction

Liver dysfunction associated with artificial nutrition in critically ill patients is a complication that seems to be frequent, but it has not been assessed previously in a large cohort of critically ill patients.

Methods

We conducted a prospective cohort study of incidence in 40 intensive care units. Different liver dysfunction patterns were defined: (a) cholestasis: alkaline phosphatase of more than 280 IU/l, gamma-glutamyl-transferase of more than 50 IU/l, or bilirubin of more than 1.2 mg/dl; (b) liver necrosis: aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l, plus bilirubin of more than 1.2 mg/dl or international normalized ratio of more than 1.4; and (c) mixed pattern: alkaline phosphatase of more than 280 IU/l or gamma-glutamyl-transferase of more than 50 IU/l, plus aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l.

Results

Seven hundred and twenty-five of 3,409 patients received artificial nutrition: 303 received total parenteral nutrition (TPN) and 422 received enteral nutrition (EN). Twenty-three percent of patients developed liver dysfunction: 30% in the TPN group and 18% in the EN group. The univariate analysis showed an association between liver dysfunction and TPN (p < 0.001), Multiple Organ Dysfunction Score on admission (p < 0.001), sepsis (p < 0.001), early use of artificial nutrition (p < 0.03), and malnutrition (p < 0.01). In the multivariate analysis, liver dysfunction was associated with TPN (p < 0.001), sepsis (p < 0.02), early use of artificial nutrition (p < 0.03), and calculated energy requirements of more than 25 kcal/kg per day (p < 0.05).

Conclusion

TPN, sepsis, and excessive calculated energy requirements appear as risk factors for developing liver dysfunction. Septic critically ill patients should not be fed with excessive caloric amounts, particularly when TPN is employed. Administering artificial nutrition in the first 24 hours after admission seems to have a protective effect.
Appendix
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Metadata
Title
Liver dysfunction associated with artificial nutrition in critically ill patients
Authors
Teodoro Grau
Alfonso Bonet
Mercedes Rubio
Dolores Mateo
Mercé Farré
José Antonio Acosta
Antonio Blesa
Juan Carlos Montejo
Abelardo García de Lorenzo
Alfonso Mesejo
the Working Group on Nutrition and Metabolism of the Spanish Society of Critical Care
Publication date
01-02-2007
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2007
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5670

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