Parenteral nutrition, sepsis, acute heart failure and hepatotoxic drugs are related to liver test disturbances in critically ill patients and feeding adequacy can still be improved.

Scriptie/Masterproef: Master-after-master

Samenvatting

Background & aims Feeding critically ill patients by the use of artificial nutrition remains a challenge. Parenteral nutrition (PN) use in clinical settings is often associated with liver dysfunction although PN is not the sole contributing factor: sepsis, acute heart failure (AHF) and hepatotoxic drugs can also deteriorate liver parameters. This study aimed to identify the impact of parameters contributing to liver disturbances with focus on PN and evaluate the feeding adequacy. Methods Adult patients admitted to a tertiary ICU for at least 3 days (Jan 2017-Dec 2019) and treated with PN (3 components) more than 3 days were included in a retrospective single center study. Patients were divided in 2 groups, those with or without functional liver disturbance, defined as 2 out of 3 liver parameters (AST, ALT or AP) elevated (≥ 1.5x upper limit of normal) at day 1 of PN. The presence of AHF, sepsis or septic shock, use of paracetamol, amoxicillin/clavulanic acid, flucloxacillin, valproate and sulfamethoxazole/trimethoprim was recorded. Volume of PN, calorie abundance, proteins, lipids and carbohydrates and duration of therapy were recorded. To assess contributions of proteins, lipids and carbohydrates on AST, ALT, AP, GGT, TB and INR, a linear mixed-effect model was used. Adequacy was defined as the caloric, protein, lipid and carbohydrate intake compared to theoretical needs. Results In 224 ICU patients (mean age 63 +/- 17 years, 38% female) treated with PN; carbohydrates significantly increased GGT, ALT and AST with and without adjustment for pre-existing liver disturbances. No evidence was found for lipids and proteins. Sepsis, paracetamol, amoxicillin/clavulanic acid, valproate, flucloxacillin and to a lesser extend AHF, deteriorated liver function. Sulfamethoxazol/trimethoprim and duration of PN treatment didn’t contribute significantly. Conclusion In critically ill patients treated with PN for at least 3 days, only volume of carbohydrates is a contributing factor to an increase levels of GGT, ALT and AST. For proteins, lipids and duration of PN treatment no evidence was found that they cause a further deterioration of liver values. Hepatotoxic drugs affect liver parameters as well as acute heart failure and sepsis/septic shock.
Datum prijs2022
Originele taalEnglish

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