000165432 001__ 165432
000165432 005__ 20260108143204.0
000165432 0247_ $$2doi$$a10.1186/cc5670
000165432 0248_ $$2sideral$$a118424
000165432 037__ $$aART-2007-118424
000165432 041__ $$aeng
000165432 100__ $$aGrau, Teodoro
000165432 245__ $$aLiver dysfunction associated with artificial nutrition in critically ill patients
000165432 260__ $$c2007
000165432 5060_ $$aAccess copy available to the general public$$fUnrestricted
000165432 5203_ $$aIntroduction: Liver dysfunction associated with artificial nutrition in critically ill patients is a complication that seems to be frequent, but it has not been assessed previously in a large cohort of critically ill patients.
Methods: We conducted a prospective cohort study of incidence in 40 intensive care units. Different liver dysfunction patterns were defined: (a) cholestasis: alkaline phosphatase of more than 280 IU/l, gamma-glutamyl-transferase of more than 50 IU/l, or bilirubin of more than 1.2 mg/dl; (b) liver necrosis: aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l, plus bilirubin of more than 1.2 mg/dl or international normalized ratio of more than 1.4; and (c) mixed pattern: alkaline phosphatase of more than 280 IU/l or gamma-glutamyl-transferase of more than 50 IU/l, plus aspartate aminotransferase of more than 40 IU/l or alanine aminotransferase of more than 42 IU/l.
Results; Seven hundred and twenty-five of 3,409 patients received artificial nutrition: 303 received total parenteral nutrition (TPN) and 422 received enteral nutrition (EN). Twenty-three percent of patients developed liver dysfunction: 30% in the TPN group and 18% in the EN group. The univariate analysis showed an association between liver dysfunction and TPN (p < 0.001), Multiple Organ Dysfunction Score on admission (p < 0.001), sepsis (p < 0.001), early use of artificial nutrition (p < 0.03), and malnutrition (p < 0.01). In the multivariate analysis, liver dysfunction was associated with TPN (p < 0.001), sepsis (p < 0.02), early use of artificial nutrition (p < 0.03), and calculated energy requirements of more than 25 kcal/kg per day (p < 0.05).
Conclusion: TPN, sepsis, and excessive calculated energy requirements appear as risk factors for developing liver dysfunction. Septic critically ill patients should not be fed with excessive caloric amounts, particularly when TPN is employed. Administering artificial nutrition in the first 24 hours after admission seems to have a protective effect.
000165432 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttps://creativecommons.org/licenses/by/4.0/deed.es
000165432 590__ $$a3.834$$b2007
000165432 591__ $$aCRITICAL CARE MEDICINE$$b4 / 19 = 0.211$$c2007$$dQ1$$eT1
000165432 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000165432 700__ $$aBonet,Alfonso
000165432 700__ $$aRubio, Mercedes
000165432 700__ $$aMateo, Dolores
000165432 700__ $$aFarré, Mercé
000165432 700__ $$aAcosta, José Antonio
000165432 700__ $$aBlesa, Antonio
000165432 700__ $$aMontejo, Juan Carlos
000165432 700__ $$aGarcía de Lorenzo, Abelardo
000165432 700__ $$aMesejo, Alfonso
000165432 700__ $$0(orcid)0000-0002-8068-5016$$aSerón Arbeloa, Carlos$$uUniversidad de Zaragoza
000165432 700__ $$aand the Working Group on Nutrition and Metabolism of the Spanish Society of Critical Care
000165432 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000165432 773__ $$g11, 1 (2007), [12 pp.]$$pCrit. care$$tCritical care$$x1364-8535
000165432 8564_ $$s71417$$uhttps://zaguan.unizar.es/record/165432/files/texto_completo.pdf$$yVersión publicada
000165432 8564_ $$s2394192$$uhttps://zaguan.unizar.es/record/165432/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000165432 909CO $$ooai:zaguan.unizar.es:165432$$particulos$$pdriver
000165432 951__ $$a2026-01-08-14:10:31
000165432 980__ $$aARTICLE