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

  • Mateu-de Antonio, Javier1
  • Miana-Mena, María Teresa2
  • Martínez-Bernabé, Eva3
  • González-Valdivieso, Juan4
  • Berlana, David5
  • Pons-Bussom, Montserrat6
  • Murgadella-Sancho, Anna7
  • Badia-Tahull, Maria B8
  • Martínez-Castro, Beatriz9
  • Sunyer-Esquerrà, Neus10
  • Sanmartin-Suñer, Mónica11
  • Leiva-Badosa, Elisabet8
  • Mirerachs-Aranda, Nuria12
  • Vila-Bundó, Anna13
  • Fernández-Morató, Jordi14
  • Vitales-Farrero, María Teresa15
  • 1 Pharmacy Department, Hospital del Mar, Barcelona, Spain. , (Spain)
  • 2 Pharmacy Department, Hospital Clínic de Barcelona, Barcelona, Spain. , (Spain)
  • 3 Pharmacy Department, Corporació de Salut del Maresme i la Selva, Blanes, Spain. , (Spain)
  • 4 Pharmacy Department, Consorci Sanitari de Terrassa, Terrassa, Spain. , (Spain)
  • 5 Pharmacy Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain. , (Spain)
  • 6 Pharmacy Department, Hospital Universitari Sagrat Cor, Barcelona, Spain. , (Spain)
  • 7 Pharmacy Department, Hospital Dos de Maig, Barcelona, Spain. , (Spain)
  • 8 Hospital Universitari Bellvitge, IDIBELL, Hospitalet de Llobregat, Spain. , (Spain)
  • 9 Pharmacy Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain. , (Spain)
  • 10 Pharmacy Department, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain. , (Spain)
  • 11 Pharmacy Department, Quironsalud Hospital General de Catalunya, Sant Cugat del Vallès, Spain. , (Spain)
  • 12 Pharmacy Department, Fundació Hospital Esperit Sant, Santa Coloma de Gramenet, Spain. , (Spain)
  • 13 Pharmacy Department, Fundació Sanitària Mollet, Mollet del Vallès, Spain. , (Spain)
  • 14 Pharmacy Department, Centro Médico Teknon, Barcelona, Spain. , (Spain)
  • 15 Pharmacy Department, Consorci Hospitalari de Vic, Vic, Spain. , (Spain)
Published Article
JPEN. Journal of parenteral and enteral nutrition
Publication Date
Mar 01, 2021
DOI: 10.1002/jpen.1865
PMID: 32384172


Our objective was to assess in non-critically-ill adult inpatients receiving parenteral nutrition (PN) the risk of developing liver function test (LFT) alterations when receiving concomitant possibly hepatotoxic medications or others reported to improve LFTs during PN. A multicenter retrospective analysis of prospectively collected data was performed on patients receiving PN. Two groups were recruited: group LALT (patients with any LFT alterations during PN), and group NOLALT (patients without such alterations). Exclusion criteria were previous sepsis, shock, renal failure, hyperglycemia, LFT alteration, or biliopancreatic surgical procedures. Medications were classified into 2 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). The study included 200 patients, 136 (68.0%) in the LALT group. The groups differed in the number of patients requiring surgical intervention ≤7 days before PN (LALT, 94 [69.1%]; NOLALT, 29 [45.3%]; P < .002) and those receiving possibly hepatotoxic medications (LALT, 126 [92.6%]; NOLALT, 45 [70.3%]; P < .001). Variables in the final Cox regression model were possibly hepatotoxic medications, odds ratio (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). Patients who received PN and concomitantly possibly hepatotoxic medications had a 3-fold risk of developing LFT alterations. Medications reported to improve LFTs had no effect. The use of possibly hepatotoxic medications during PN was associated with LFT alterations. © 2020 American Society for Parenteral and Enteral Nutrition.

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