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P1.42: Nutritional, metabolic and hepatic impact associated with HPN use on stable patients undergoing Home Parenteral Nutrition (HPN)

Intestinal Failure is a severe condition defined as the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required. Patients with Chronic Intestinal Failure despite being metabolically stable patients, require intravenous supplementation over months or years. Objectives: The aim of this study was to describe the nutritional, metabolic and hepatic impairment associated with HPN use of sixteen adult patients treated at an outpatient clinic of intestinal failure (AMULSIC – Multidisciplinary Ambulatory of Short Bowel Syndrome) located in a public tertiary referral hospital in São Paulo, Brazil. The patients were stable and undergoing Home Parenteral Nutrition (HPN) for at least 12 months. Methods: Patients were evaluated according to criteria for liver disease progression related to long term parenteral nutrition therapy. The parameters utilized were: elastography (fibroscan), liver biopsy, laboratory tests (AST, ALT, alkaline phosphatase, y-GT, ferritin, bilirubins, activated partial thromboplastin time, total proteins and fractions), body mass index (BMI), body composition by electrical bioimpedance and also by indirect calorimetry for the accurate determination of individual caloric demands. Results: Sixteen patients with a mean age of 38.5 years diagnosed with chronic intestinal failure undergoing HPN were followed up for at least 12 months and a maximum of 144 months (mean of 53 months). Fibroscan analysis revealed liver fibrosis grade I in nine patients, grade II in three patients and grades III/IV in four patients. Two patients presented grade III fibrosis in liver biopsy. Three patients had excessively elevated levels of ferritin. Eleven patients present a normal range of weight, three patients presented a BMI ≥ 24 (owerweight) and two patients presented BMI ≤ 18,5 (underweight). Ten patients out of this group [PM1] showed muscle mass reduction in electrical bioimpedance. Indirect calorimetry had a 0.8 (SD:± 0,079) mean respiratory coefficient. Conclusions: In the population studied, there was no direct correlation between fibroscan results and liver biopsy and there was not a home parenteral nutrition time direct correlation with hepatic impairment. It was also observed an association between parenteral nutrition associated liver disease and high levels of ferritin, previous history of morbid obesity and intestinal pseudo-obstruction.