title: Persistent inflammation and immune activation contribute to cholestasis in patients receiving home parenteral nutrition.
abstract: Liver disease is frequent in patients taking home parenteral nutrition (HPN), but its cause remains unclear. Ongoing inflammation was implicated in HPN-associated cholestasis, so we examined the relation between liver-enzyme concentrations and circulating inflammatory and immune markers in these patients. In 17 HPN patients and 10 age- and sex-matched control subjects, we examined erythrocyte sedimentation rate, blood neopterin, soluble interleukin (IL)--2 receptors, circulating tumor necrosis factor-alpha, IL-6, aspartate and alanine aminotransferases, alkaline phosphatases, and gamma-glutamyltranspeptidase (GGT) concentrations. Fourteen of 17 patients had abnormal liver function tests with an increase in alkaline phosphatases (P < 0.001), gamma-glutamyltranspeptidase (P < 0.01), and aspartate aminotransferase (P < 0.01). Alkaline phosphatases were positively correlated to erythrocyte sedimentation rate, neopterin, tumor necrosis factor-alpha, and IL-6. gamma-Glutamyltranspeptidase was positively linked to tumor necrosis factor-alpha and soluble IL-2 receptors. There was no link between aminotransferases and inflammatory parameters. Liver-enzyme concentrations were correlated to the amount of total intravenous calories and calories originating from carbohydrates but not to infused lipids (median infused lipids x kg(-1) body weight x d(-1) = 0.62 g) in contrast to recently published data. Our results confirmed that the number of infused calories contributes to liver toxicity in HPN patients and strongly suggested that sustained inflammation is probably a key factor in worsening HPN-associated cholestasis.
authors.affiliation: Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Centre Agréé de Nutrition Parentérale à Domicile, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France. jean-marie.reimund@chru-strasbourg.fr
authors.forename: J M
authors.initials: JM
authors.lastname: Reimund
authors.forename: B
authors.initials: B
authors.lastname: Duclos
authors.forename: Y
authors.initials: Y
authors.lastname: Arondel
authors.forename: R
authors.initials: R
authors.lastname: Baumann
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D001799:Blood Sedimentation; D016022:Case-Control Studies; D002779:Cholestasis / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008107:Liver Diseases / Q000209:etiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000097:blood; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D015415:Biomarkers; D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha; D019798:Neopterin