Causes of parenteral nutrition-associated liver dysfunction in patients receiving parenteral nutrition at home — retrospective observational study

The purpose of this study was to investigate factors related to nutrient mixture composition that contribute to the liver complications in patients chronically treated with parenteral nutrition. The retrospective study included 94 patients (53 female, 41 male), aged 24 to 81 years (mean age 54.5 years). Patients were followed up every 3 months on average, which was the basis for dividing the course of treatment of each patient into treatment periods. A single treatment period with a follow-up at the end was used as the basic unit for comparative analyses presented below. A total of 371 treatment periods were analyzed. If the follow-up laboratory tests showed increased total bilirubin levels or increased AspAT/AlAT activity, the preceding treatment period was classified into the "complications" group (group II); if the follow-up results were normal, the treatment period was classified into the "no complications" group (group I). In the treatment periods with increased aminotransferase activity and bilirubin levels at follow-up, patients received significantly more lipids and glucose per kilogram of body weight. In the entire study group, there was a correlation between glucose intake per kg/bw and occurrence of liver complications affecting aminotransferase activity and bilirubin concentration. Conclusions: high dosage of glucose and lipids is the primary factor in the pathogenesis of liver complications. The type of lipid emulsion has little significance. The maximum dosage of glucose and lipids, above which liver dysfunctions are more than 90% likely to occur, is 4.721 g of glucose kg/bw, and 1.276 g of lipids kg/bw.