Chronic biochemical cholestasis in patients receiving home parenteral nutrition: prevalence and predisposing factors.
BACKGROUND
Chronic biochemical cholestasis has been shown to be associated with a fivefold increase in histologically advanced liver disease in patients receiving home parenteral nutrition.


OBJECTIVE
To investigate prevalence of chronic biochemical cholestasis in home parenteral nutrition patients and examine factors influencing its occurrence.


METHODS
Records of all patients receiving home parenteral nutrition for >6 months treated at a single centre were reviewed and plasma biochemistry recorded. Logistic regression analysis was employed to identify factors associated with prevalence of chronic biochemical cholestasis.


RESULTS
Records of 113 patients were reviewed. The point prevalence of chronic biochemical cholestasis was 24%, increasing to 28% if patients receiving parenteral fluid and electrolytes only were excluded. In multivariate analysis, presence of colon in continuity was associated with a significantly lower prevalence of chronic biochemical cholestasis, while total parenteral calorie intake was associated with a higher prevalence of chronic biochemical cholestasis. No association was seen between small intestinal lengths or between parenteral lipid intake and chronic biochemical cholestasis in multivariate analysis.


CONCLUSIONS
Chronic biochemical cholestasis is common in patients receiving home parenteral nutrition. High parenteral calorie intake and lack of a colon in continuity with small intestine are independently associated with an increased risk of chronic biochemical cholestasis.
Lloyd
D A J
DA
Lennard-Jones Intestinal Failure Unit, St Mark's Hospital and Academic Institute, Harrow, UK. dajl@btinternet.com
Zabron
A A
AA
Gabe
S M
SM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002779:Cholestasis / Q000201:enzymology / Q000453:epidemiology / Q000209:etiology*; D002908:Chronic Disease; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology