ETIOLOGY AND OUTCOME OF TOTAL PARENTERAL NUTRITION-INDUCED HEPATIC-DYSFUNCTION

Hepatic dysfunction is commonly encountered during total parenteral nu trition (TPN), but it is likely that factors other than TPN play an im portant role. This study divides TPN patients, before TPN administrati on, into two groups according to whether the pre-TPN liver function te st was normal or abnormal. Among the 729 cases studied, liver function impairment was progressively downhill in patients with abnormal pre-T PN liver function, but liver function maintained normal in most patien ts with normal pre-TPN liver function test. The TPN formula did not di ffer between the two groups. Thus, TPN formula itself is probably not a crucial causal factor for hepatic dysfunction. Instead, the etiology of that dysfunction is more likely a result of multiple factors. From this study, it is suggested that digestive disease, nothing per os, a nd infections all play an important role (P < 0.001). The rates of mor bidity, mortality, and organ failure are significantly increased in th e group with abnormal pre-TPN liver function (P < 0.05). Aggressive tr eatment of underlying disease and early restoration of enteral feeding are suggested to reduce TPN-induced hepatic dysfunction.