Lipid-Free Parenteral Nutrition Is Associated with an Increased Risk of Hepatic Dysfunction in Surgical Critically Ill Patients: A Retrospective Observational Study.

Shih-Chi Wu,I-Ju Tsai,Te-An Chen,Chia-Wei Tzeng,Han-Tsung Cheng,Chih-Hsin Muo,Chia-Hao Hsu,Yu-Chun Wang

doi:10.3390/healthcare9091096

Shih-Chi Wu, I-Ju Tsai + Show 6 more

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https://doi.org/10.3390/healthcare9091096

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Abstract

To evaluate the effects of lipid-free parenteral nutrition (PN) and various intravenous fat emulsions (IVFEs) on hepatic function in surgical critically ill trauma/acute care surgery patients. We retrospectively reviewed trauma/acute care surgery patients without admission hepatic disorder that received PN. The PN groups include lipid-free, soybean oil/medium-chain triglyceride, olive oil-based, and fish-oil contained PN. We excluded patients with (1) age <18 years, (2) without surgery, (3) preexisting liver injury/diseases, (4) hyperbilirubinemia at admission, (5) received more than one type of PN, and (6) repeated ICU episodes in the same hospitalization. Hepatic dysfunction was considered as serum total–bilirubin >6.0 mg/dL. The demographics, severity score, comorbidities, blood stream infection, and mortality were collected for analyses. The major outcome is hepatic function. We also performed analyses stratified by separated lipid doses (g/kg/day). A total of 249 patients were enrolled. There were no demographic differences among groups. The lipid-free PN group had a higher incidence of hepatic dysfunction and mortality. Compared to the lipid-free group, the other three IVFEs had significantly lower risks of hepatic dysfunction, while the olive oil-based group had a significantly lower risk of 30 and 90-day mortality. After being stratified by separating lipid doses, the soybean oils showed a decreasing trend of hepatic dysfunction and mortality with increased dosage. Fish oil >0.05 g/kg/day was associated with lower hepatic dysfunction incidences. Our findings suggest that, when compared to IVFEs, surgical critically ill patients with trauma/acute care surgery that received lipid-free PN are associated with an increased risk of hepatic dysfunction. In addition, the olive oil-based group had a significantly lower risk of mortality, while fish oil >0.05 g/kg/day was associated with lower incidences of hepatic dysfunction; however, further studies are warranted.

Highlights

Parenteral nutrition (PN) is essential in intestinal failure or intolerable to oral or enteral nutrition (EN) for prolonged periods [1,2]
Soybean-based IVLE are high in linoleic acid, which is abundant in essential n-6 polyunsaturated fatty acids (PUFAs) and high phytosterol concentrations [3], which was thought to aggravate inflammatory immune response and have adverse outcomes [10]
Though without significance, we found that fish oil dosages 0.05 g/kg/day had a lower risk when compared to non-fish oil use (Tables 4 and 5), indicating the importance of fish oil dosage

Summary

Introduction

Parenteral nutrition (PN) is essential in intestinal failure or intolerable to oral or enteral nutrition (EN) for prolonged periods [1,2]. IV fat emulsions (IVFEs) have been an important component of PN, which provide cellular energy and essential fatty acids [3,4]. The major components of fat emulsions may include soybean oil, olive oil, fish oil, and coconut oil-based IVFEs [4,5]. Soybean-based IVLE are high in linoleic acid (about 50%), which is abundant in essential n-6 polyunsaturated fatty acids (PUFAs) and high phytosterol concentrations [3], which was thought to aggravate inflammatory immune response and have adverse outcomes [10]. Due to the large amount of n-9 monounsaturated fatty acids and dilution of the pro-inflammatory effect of n-6 PUFAs, olive oil-based IVLE is generally considered immunologically neutral [12]

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