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A cohort Multicenter Study on the Role of Medications on Parenteral Nutrition Related Alteration of Liver Function Tests in Adults.

BACKGROUND
Our objective was to assess the risk in non-critically-ill adult inpatients on parenteral nutrition (PN) of developing liver function test (LFT) alterations when receiving concomitant possibly hepatotoxic medications or others reported to improve LFTs during PN.


MATERIAL AND METHODS
A multicenter retrospective analysis of prospectively collected data was performed on patients receiving PN. Two groups were recruited: group LALT included patients with any LFT alterations during PN, and group NOLALT, those who did not present such alterations. Exclusion criteria were previous sepsis, shock, renal failure, hyperglycemia, LFT alteration or biliopancreatic surgical procedures. Medications were classified into two categories: medications reported to improve LFTs during PN (n = 8) and possibly hepatotoxic medications (n = 54), including a subgroup of possibly highly hepatotoxic medications (n = 30).


RESULTS
The study included 200 patients, 136 (68.0%) in the LALT group, and 64 (32.0%) in the NOLALT group. The groups differed in the number of patients requiring surgical intervention ≤7 days prior to PN (LALT, 94 [69.1%]; NOLALT, 29 [45.3%]; p<0.002) and in those receiving possibly hepatotoxic medications (LALT, 126 [92.6%]; NOLALT, 45 [70.3%]; p<0.001). Variables in the final Cox regression model were possibly hepatotoxic medications, OR 3.310 (1.678-6.530); surgical intervention prior to PN, OR 1.861 (1.277-2.711); baseline triglyceridemia, OR 1.005 (1.001-1.009) and creatinine, OR 1.861 (1.043-3.323).


CONCLUSIONS
Patients requiring PN who concomitantly received possibly hepatotoxic medications had a three-fold risk of developing LFT alterations. Medications reported to improve LFTs during PN had no effect. The use of possibly hepatotoxic medications during PN was associated with LFT alterations. This article is protected by copyright. All rights reserved.