title: Choline deficiency is associated with increased risk for venous catheter thrombosis.
abstract: BACKGROUND
  Patients with intestinal failure who require long-term parenteral nutrition (PN) develop catheter thrombosis as a complication. This patient group may also develop choline deficiency because of a defect in the hepatic transsulfuration pathway in the setting of malabsorption. This study was undertaken to determine whether choline deficiency is a risk factor for development of catheter thrombosis.
  
  
  METHODS
  Plasma free and phospholipid-bound choline concentrations were measured in a group of 41 patients that required long-term PN. Episodes of catheter thrombosis from onset of PN to the time of blood testing were recorded.
  
  
  RESULTS
  Sixteen (39%) patients developed catheter thrombosis, and 5 of these had recurrent catheter thrombosis. Plasma free choline was 7.7 +/- 2.7 nmol/mL in patients with no history of catheter thrombosis and 6.2 +/- 1.7 nmol/mL in patients with previous catheter thrombosis (p = .076 by Wilcoxon rank-sum test). The partial correlation between plasma free choline concentration and the frequency of clots after controlling for catheter duration was r = -0.33 (p = .038). The relative risk for catheter thrombosis in subjects with a plasma free choline concentration <8 nmol/mL was 10.0, 95% confidence interval (1.134-88.167). Plasma phospholipid-bound choline concentration was 2191.7 +/- 679.0 nmol/mL in patients with previous catheter thrombosis and 2103.3 +/- 531.2 nmol/mL in patients without history of catheter thrombosis (p = NS).
  
  
  CONCLUSIONS
  Choline deficiency is a significant risk factor for development of catheter thrombosis in patients with intestinal failure who require PN.
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. a-buchman@northwestern.edu
authors.forename: Alan L
authors.initials: AL
authors.lastname: Buchman
authors.forename: Marvin E
authors.initials: ME
authors.lastname: Ament
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Jenden
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
mesh_terms: D000328:Adult; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002794:Choline / Q000097:blood*; D002796:Choline Deficiency / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects; D010743:Phospholipids / Q000032:analysis / Q000378:metabolism*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology
chemical_list: D010743:Phospholipids; D002794:Choline