[Risk factors of the hepatic dysfunction associated with parenteral nutrition].
OBJECTIVE
The objective of this study is to describe the incidence of hepatic dysfunction (HD) in our hospital and evaluate the possible risk factors associated with HD development as an improvement of the caring process received by patients treated with parenteral nutrition (PN).


METHODS
A prospective study of patients (n=994) who required PN during the period 2000-2004. HD is the identification of an increase above 1,5 of the top reference value of alkaline phosphatase (40-450U/l) and gamma glutamyl transpeptidase (11-49U/l) associated with an increase of transaminases (5-32U/l) and a total bilirrubin higher than 1,2mg/dl.


RESULTS
The incidence of HD was 4,9% (n=49). Days with PN were significantly higher in the HD group: median (interquartile range): 30 (20-59) vs 15 (8-25) days (p<0.001). In the univariated HD analysis, the variables that reached significant odds ratio were: the critical patient condition, the PN duration, the total calorie contribution higher than 25kcal/kg, to exceed 3g of carbohydrates/kg, to administer more than 0.8g/kg of lipids and to exceed 0.16g of nitrogen/kg. In the multivariated analysis, the variables selected as independent risk factors were: to exceed 3 weeks of PN, to be a critical patient and a contribution over 0.16g of nitrogen/kg.


CONCLUSIONS
The present profiles of the patients who will develop HD are those with prolonged PN. These patients undergo processes and critical therapy, where the specialists must monitor, not only calorie contribution, carbohydrates or lipids, but proteins as well.
Servia
Luis
L
Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España. lservia@telefonica.net
Schoenenberger
Joan Antonio
JA
Trujillano
Javier
J
Badia
Mariona
M
Rodríguez-Pozo
Angel
A
D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors