Changes in the pattern of visceral protein concentrations after internal biliary drainage in patients with obstructive jaundice

Objective: To evaluate the influence of internal drainage on status of nutr itional markers in patients with obstructive jaundice. Dessing. Prospective longitudinal study. Setting: University hospital, Spai n. Subjects: 39 patients with obstructive jaundice (18 benign and 21 malignant obstructions). Interventions: Nutritional state was assessed before and 10 days after endo scopic drainage. Main outcome measures: One anthropometric (body weight < 95% of ideal) and two biochemical (albumin <35 gn and prealbumin < 170 mg/L) as an indication of protein calorie malnutrition. Retinol binding protein and transferrin c oncentrations, total lymphocyte count, and nutritional prognostic index (NP I) were also measured. Results: Thirty patients (77%) had protein calorie malnutrition. After inte rnal drainage, 6 patients with benign obstruction and Il with malignant tum ours remained malnourished. No anthropometric variables or concentrations o f proteins with long half-lives were affected by drainage. However, prealbu min (p < 0.01) and transferrin (p < 0.01) concentrations, and total lymphoc yte count (p < 0.001) increased significantly in both groups. NPI also impr oved significantly after drainage from 33 (9) compared with 37 (5) in benig n obstructions (p < 0.05) and 58.7 (14) compared with 52 (12) in malignant (p < 0.05), although in the latter group the mean nutritional risk index re mained high. Conclusions: Concentrations of some of the visceral proteins studied (preal bumin and transferrin) improved 10 days after internal biliary drainage for both benign and malignant obstruction. However, many patients with maligna nt rumours remained malnourished with a high nutritional risk index.