Assessing Non-Invasive Liver Function in Patients with Intestinal Failure Receiving Total Parenteral Nutrition—Results from the Prospective PNLiver Trial

Nutrients, vol. 12, pp. 1217

Abstract

Liver abnormalities in intestinal failure (IF) patients receiving parenteral nutrition (PN) can progress undetected by standard laboratory tests to intestinal failure associated liver disease (IFALD). The aim of this longitudinal study is to evaluate the ability of non-invasive liver function tests to assess liver function following the initiation of PN. Twenty adult patients with IF were prospectively included at PN initiation and received scheduled follow-up assessments after 6, 12, and 24 months between 2014 and 2019. Each visit included liver assessment (LiMAx [Liver Maximum Capacity] test, ICG [indocyanine green] test, FibroScan), laboratory tests (standard laboratory test, NAFLD [non-alcoholic fatty liver disease] score, FIB–4 [fibrosis-4] score), nutritional status (bioelectrical impedance analysis, indirect calorimetry), and quality of life assessment. The patients were categorized post-hoc based on their continuous need for PN into a reduced parenteral nutrition (RPN) group and a stable parenteral nutrition (SPN) group. While the SPN group (n = 9) had significantly shorter small bowel length and poorer nutritional status at baseline compared to the RPN group (n = 11), no difference in liver function was observed between the distinct groups. Over time, liver function determined by LiMAx did continuously decrease from baseline to 24 months in the SPN group but remained stable in the RPN group. This decrease in liver function assessed with LiMAx in the SPN group preceded deterioration of all other investigated liver function tests during the study period. Our results suggest that the liver function over time is primarily determined by the degree of intestinal failure. Furthermore, the LiMAx test appeared more sensitive in detecting early changes in liver function in comparison to other liver function tests.

Authors 11

1. Elisabeth Blüthner corresponding

   Stiftung Charité · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany

   Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

2. Ulrich‐Frank Pape

   Asklepios Klinik St. Georg · Asklepios Kliniken Hamburg

   Affiliation as printed

   Department of Internal Medicine and Gastroenterology | Asklepios Klinik St. Georg, Asklepios Medical School, Lohmühlenstr. 5, 20099 Hamburg, Germany

3. Martin Stockmann

   Paul Gerhardt Diakonie · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of General, Visceral and Vascular Surgery, Evangelisches Krankenhaus Paul Gerhardt Stift, Paul-Gerhardt-Str. 42-45, 06886 Lutherstadt Wittenberg, Germany

   Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

4. Mirjam Karber

   Berlin Institute of Health at Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany

5. Sebastian Maasberg

   Asklepios Klinik St. Georg · Asklepios Kliniken Hamburg

   Affiliation as printed

   Department of Internal Medicine and Gastroenterology | Asklepios Klinik St. Georg, Asklepios Medical School, Lohmühlenstr. 5, 20099 Hamburg, Germany

6. Sophie Pevny

   Stiftung Charité · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany

7. Undine A. Gerlach-Runge

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

8. Andreas Pascher

   University Hospital Münster

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany

9. Johann Pratschke

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

10. Frank Tacke

    Stiftung Charité · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Gastroenterology and Hepatology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany

11. Jan Bednarsch Aachen Department of General, Visceral and Transplantation Surgery

    Universitätsklinikum Aachen · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Rhine-Westphalia Institute of Technology, Pauwelsstraße 30, 52074 Aachen, Germany

    Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany