Department of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium.
Department of Clinical Nutrition, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium.
Nutrients. 2023 Jun 2;15(11):2612. doi: 10.3390/nu15112612.
Parenteral nutrition (PN) is often associated with liver dysfunction in the ICU, although other factors such as sepsis, acute heart failure (AHF), and hepatotoxic drugs can be equally present. The relative impact of PN on liver dysfunction in critically ill patients is largely unknown.
We recorded the presence of pre-existing liver disturbances, AHF, sepsis, daily PN volume, and commonly used hepatotoxic drugs in adult ICU patients, together with daily aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), alkalic phosphatase (AP), total bilirubin (TB), and INR values in patients with three or more PN treatment days. A linear mixed-effects model was used to assess the relative contribution of each liver parameter. Nutritional adequacy was defined as intake/needs.
We included 224 ICU patients with PN treatment lasting more than 3 days between 1 January 2017 and 31 December 2019. For AST, pre-existing liver disturbances (+180% ± 11%) and the presence of AHF (+75% ± 14%) were the main predictors of deterioration, whereas PN volume caused only a limited increase of 14% ± 1%/L. Similar results were observed for ALT. GGT, INR, and TB are mainly influenced by the presence of sepsis/septic shock and pre-existing liver disturbances, with no impact of PN or hepatotoxic drugs. Carbohydrate intake exceeded recommendations, and protein and lipid intake were insufficient in this study cohort.
Liver test disturbances in ICU patients on PN are multifactorial, with sepsis and AHF having the highest influence, with only limited impact from PN and hepatotoxic drugs. Feeding adequacy can be improved.
肠外营养（PN）在 ICU 中常与肝功能障碍相关，尽管其他因素如脓毒症、急性心力衰竭（AHF）和肝毒性药物也同样存在。PN 对危重症患者肝功能障碍的相对影响在很大程度上尚不清楚。
我们记录了 ICU 成年患者中存在的预先存在的肝障碍、AHF、脓毒症、每日 PN 量和常用的肝毒性药物，以及具有 3 天以上 PN 治疗的患者的每日天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、γ-谷氨酰转移酶（GGT）、碱性磷酸酶（AP）、总胆红素（TB）和国际标准化比值（INR）值。采用线性混合效应模型评估每个肝参数的相对贡献。营养充足定义为摄入量/需求量。
我们纳入了 2017 年 1 月 1 日至 2019 年 12 月 31 日期间接受超过 3 天 PN 治疗的 224 例 ICU 患者。对于 AST，预先存在的肝障碍（增加 180%±11%）和 AHF 的存在（增加 75%±14%）是恶化的主要预测因素，而 PN 量仅引起 14%±1%/L 的有限增加。ALT 也观察到类似的结果。GGT、INR 和 TB 主要受脓毒症/感染性休克和预先存在的肝障碍的影响，PN 或肝毒性药物没有影响。在本研究队列中，碳水化合物的摄入量超过了建议量，而蛋白质和脂肪的摄入量则不足。
PN 治疗的 ICU 患者的肝试验异常是多因素的，脓毒症和 AHF 的影响最大，PN 和肝毒性药物的影响有限。可以改善喂养充足性。
