Etiology and outcome of total parenteral nutrition-induced hepatic dysfunction

Hepatic dysfunction is commonly encountered during total parenteral nutrition (TPN), but it is likely that factors other than TPN play an important role. This study divides TPN patients, before TPN administration, into two groups according to whether the pre-TPN liver function test was normal or abnormal. Among the 729 cases studied, liver function impairment was progressively downhill in patients with abnormal pre-TPN liver function, but liver function maintained normal in most patients with normal pre-TPN liver function test. The TPN formula did not differ between the two groups. Thus, TPN formula itself is probably not a crucial causal factor for hepatic dysfunction. Instead, the etiology of that dysfunction is more likely a result of multiple factors. From this study, it is suggested that digestive disease, nothing per os, and infections all play an important role (P < 0.001). The rates of morbidity, mortality, and organ failure are significantly increased in the group with abnormal pre-TPN liver function (P < 0.05). Aggressive treatment of underlying disease and early restoration of enteral feeding are suggested to reduce TPN-induced hepatic dysfunction.