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Liver dysfunction associated with artificial nutrition in critically ill patients
Teodoro Grau1, Alfonso Bonet, Mercedes Rubio
1Intensive Care Unit, Hospital Severo Ochoa, Madrid, Spain. tgrau.hdoc@salud.madrid.org
Critical Care (London, England)
|January 27, 2007
Summary
Total parenteral nutrition (TPN) and excessive calories increase liver dysfunction risk in critically ill patients. Early artificial nutrition may offer protection, especially in septic patients.
Area of Science:
- Critical care medicine
- Gastroenterology
- Nutritional support
Background:
- Liver dysfunction is a frequent complication in critically ill patients receiving artificial nutrition.
- Previous large-scale cohort studies assessing this complication are lacking.
Purpose of the Study:
- To investigate the incidence and risk factors of liver dysfunction in critically ill patients receiving artificial nutrition.
Main Methods:
- Prospective cohort study in 40 ICUs.
- Defined patterns of liver dysfunction: cholestasis, liver necrosis, and mixed.
- Analyzed associations between artificial nutrition type, patient factors, and liver dysfunction.
Main Results:
- 23% of 725 artificially nourished patients developed liver dysfunction.
- Higher incidence in total parenteral nutrition (TPN) group (30%) vs. enteral nutrition (EN) group (18%).
- Multivariate analysis identified TPN, sepsis, early artificial nutrition, and excessive energy intake (>25 kcal/kg/day) as significant risk factors.
Conclusions:
- TPN, sepsis, and excessive caloric intake are risk factors for liver dysfunction.
- Avoid excessive calories in septic patients, particularly with TPN.
- Early artificial nutrition (within 24 hours) may be protective.
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