165432 20260108143204.0 doi 10.1186/cc5670 sideral 118424 ART-2007-118424 eng Grau, Teodoro Liver dysfunction associated with artificial nutrition in critically ill patients 2007 Introduction: 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. Access copy available to the general public Unrestricted info:eu-repo/semantics/openAccess by https://creativecommons.org/licenses/by/4.0/deed.es 3.834 2007 CRITICAL CARE MEDICINE 4 / 19 = 0.211 2007 Q1 T1 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Bonet,Alfonso Rubio, Mercedes Mateo, Dolores Farré, Mercé Acosta, José Antonio Blesa, Antonio Montejo, Juan Carlos García de Lorenzo, Abelardo Mesejo, Alfonso Serón Arbeloa, Carlos Universidad de Zaragoza (orcid)0000-0002-8068-5016 and the Working Group on Nutrition and Metabolism of the Spanish Society of Critical Care 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 11, 1 (2007), [12 pp.] Crit. care Critical care 1364-8535 71417 http://zaguan.unizar.es/record/165432/files/texto_completo.pdf Versión publicada 2394192 http://zaguan.unizar.es/record/165432/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:165432 articulos driver 2026-01-08-14:10:31 ARTICLE