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Mateu-de Antonio J, Miana-Mena MT, Martínez-Bernabé E, González-Valdivieso J, Berlana D, Pons-Bussom M, Murgadella-Sancho A, Badia-Tahull MB, Martínez-Castro B, Sunyer-Esquerrà N, Sanmartin-Suñer M, Leiva-Badosa E, Mirerachs-Aranda N, Vila-Bundó A, Fernández-Morató J, Vitales-Farrero MT. Cohort Multicenter Study on the Role of Medications in Parenteral Nutrition-Related Alteration of Liver Function Tests in Adults. JPEN J Parenter Enteral Nutr 2020; 45:633-642. [PMID: 32384172 DOI: 10.1002/jpen.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/29/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Our objective was to assess in non-critically-ill adult inpatients receiving parenteral nutrition (PN) the risk of developing liver function test (LFT) alterations when receiving concomitant possibly hepatotoxic medications or others reported to improve LFTs during PN. METHODS A multicenter retrospective analysis of prospectively collected data was performed on patients receiving PN. Two groups were recruited: group LALT (patients with any LFT alterations during PN), and group NOLALT (patients without such alterations). Exclusion criteria were previous sepsis, shock, renal failure, hyperglycemia, LFT alteration, or biliopancreatic surgical procedures. Medications were classified into 2 categories: medications reported to improve LFTs during PN (n = 8) and possibly hepatotoxic medications (n = 54), including a subgroup of possibly highly hepatotoxic medications (n = 30). RESULTS The study included 200 patients, 136 (68.0%) in the LALT group. The groups differed in the number of patients requiring surgical intervention ≤7 days before PN (LALT, 94 [69.1%]; NOLALT, 29 [45.3%]; P < .002) and those receiving possibly hepatotoxic medications (LALT, 126 [92.6%]; NOLALT, 45 [70.3%]; P < .001). Variables in the final Cox regression model were possibly hepatotoxic medications, odds ratio (OR) 3.310 (1.678-6.530); surgical intervention prior to PN, OR 1.861 (1.277-2.711); baseline triglyceridemia, OR 1.005 (1.001-1.009); and creatinine, OR 1.861 (1.043-3.323). CONCLUSIONS Patients who received PN and concomitantly possibly hepatotoxic medications had a 3-fold risk of developing LFT alterations. Medications reported to improve LFTs had no effect. The use of possibly hepatotoxic medications during PN was associated with LFT alterations.
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Affiliation(s)
| | | | | | | | - David Berlana
- Pharmacy Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | - Neus Sunyer-Esquerrà
- Pharmacy Department, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Mónica Sanmartin-Suñer
- Pharmacy Department, Quironsalud Hospital General de Catalunya, Sant Cugat del Vallès, Spain
| | | | | | - Anna Vila-Bundó
- Pharmacy Department, Fundació Sanitària Mollet, Mollet del Vallès, Spain
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Arenas Villafranca JJ, Nieto Guindo M, Álvaro Sanz E, Moreno Santamaria M, Garrido Siles M, Abilés J. Effects of cyclic parenteral nutrition on parenteral-associated liver dysfunction parameters. Nutr J 2017; 16:66. [PMID: 28978317 PMCID: PMC5628441 DOI: 10.1186/s12937-017-0289-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
Introduction One of the most common complications of parenteral nutrition (PN) is liver dysfunction (LD). Therapeutic approaches for LD include, among others, administering cyclic parenteral nutrition (cPN), allowing some hours for metabolic rest. The purpose of this study was to evaluate the effectiveness of cPN in treating PN-associated LD. Materials and methods A retrospective observational study was carried out at the Costa del Sol Hospital in Spain between 2013 and 2014. The study involved inpatients ≥18 years old prescribed with cPN due to the development of PN-associated LD. The hepatic biochemical parameters measured at baseline and after completion of cPN included aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and total bilirubin (TB). Quantitative values (age, biochemical parameters) were compared using matched Student’s t-test; the mean change in qualitative variables (sex, indication of PN, hepatic comorbidities, presence of insulin in cPN, infection during cPN, management of LD prior to cPN administrarion) was estimated using Mann-Whitney U test, and bivariate correlation between quantitative variables was determined by Spearman’s coefficient of correlation. Results Thirty-seven patients met inclusion criteria. All hepatic function parameters except ALP improved after the administration of cPN, with statistically significant differences (p < 0.05) in AST GGT and TB. Conclusion cPN improves PN-associated LD by restoring abnormal AST, GGT, and BT levels to normal, and reducing ALT levels close to normal. The results obtained suggest that the administration of cPN is effective in reverting PN-associated LD.
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Affiliation(s)
- Jose J Arenas Villafranca
- Pharmacy and Nutrition Service, Costa del Sol Hospital, A7, km. 187, 29603, Marbella (Málaga), Spain
| | - Miriam Nieto Guindo
- Pharmacy and Nutrition Service, Costa del Sol Hospital, A7, km. 187, 29603, Marbella (Málaga), Spain
| | - Elena Álvaro Sanz
- Pharmacy and Nutrition Service, Costa del Sol Hospital, A7, km. 187, 29603, Marbella (Málaga), Spain. .,, C/ Fernando Villalón Edf. Lorcrisur, Bloque n°8, Bajo A, 29670, Marbella (Málaga), Spain.
| | - Manuela Moreno Santamaria
- Pharmacy and Nutrition Service, Costa del Sol Hospital, A7, km. 187, 29603, Marbella (Málaga), Spain
| | - Marga Garrido Siles
- Pharmacy and Nutrition Service, Costa del Sol Hospital, A7, km. 187, 29603, Marbella (Málaga), Spain
| | - Jimena Abilés
- Pharmacy and Nutrition Service, Costa del Sol Hospital, A7, km. 187, 29603, Marbella (Málaga), Spain
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