Patterns of transaminase elevation in patients on TPN and association with mortality

Document Type

Conference Proceeding

Publication Date

7-4-2025

Publication Title

Gut

Abstract

Background There are three primary types of parenteral nutrition- associated liver disease: steatosis- benign, although can progress to cirrhosis in patients receiving long-term PN, cholestasis- serious and can progress to cirrhosis and liver failure, and gallbladder sludge stones. Risk Factors included excess calories or lipids. Our study aims to study different patterns of transaminase elevation, determine If the cholestatic or hepatocellular pattern is more predominant, and finally if a certain kind of elevation has a higher mortality risk. Methods A retrospective chart review was conducted of all adults at our center between 2014-2024, who had a history of elevated liver enzymes while on TPN. Data on indication for TPN, prior history of liver disease, pattern of injury, workup obtained, use of growth factors, and mortality was collected. Results A total of 111 patients with elevated liver enzymes were included. 63 (56.7%) patients had a history of liver disease with the most common indications for TPN being prolonged malnutrition in 41 (36.9%) patients, and short gut syndrome in 39 (35.1%). Mortality occurred in 52 (46.8%) patients. There was no association between the elevation of AST and mortality, p-0.422, the mean time of death from the peak is 38.56 days in the population with transient (< 30 days duration) and 301.69 days in the population with persistent elevation (> 30 days). There was a statistically significant association of ALT with mortality with p- 0.022, with a mean time to mortality of 63.83 days and 328.1 days. There was a statistical association between ALP and mortality with p- 0.034, with a mean time to mortality in 70.8 days and 328.1 days. As for bilirubin, there is no association and the duration to death is 70.8 days and 190.8 days. Further people with TPN change had a higher association with p-0.007, with a mean time to death of 31.79 in the change group versus 36 days in the no change group. Most changes in TPN were associated with ALP and T bili elevation with p- 0.028 and .036 respectively. Conclusions Results indicate ALT elevation is more strongly associated with mortality followed by ALP. The pattern of liver injury more predominant was cholestatic leading to TPN change and further mortality..

Volume

74

Issue

Suppl_3

First Page

A232

Last Page

A233

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