Factors predicting nutritional derangements in patients with obstructive jaundice: Multivariate analysis

Patients with obstructive jaundice (OJ) that requires surgery often have ma lnutrition associated with increased perioperative morbidity This study inv estigated the factors influencing nutritional derangements in these patient s, A series of 46 OJ patients were investigated prospectively (28 malignant tumors, 18 benign obstructions). A nutritional risk index of < 83.5 was us ed to define protein-calorie malnutrition. Liver function, cholecystokinin (CCK) tumor necrosis factor-Lu (TNF alpha), and endotoxin levels were deter mined. A multivariate analysis was performed, and an obstructive jaundice m alnutrition index (OJMI) was obtained, Altogether, 22 (48%) OJ patients had malnutrition (33% with benign obstructions, 57% with malignant disease), M alnourished patients had higher serum bilirubin levels (258 +/- 120 vs. 154 +/- 62 mmol/L; p = 0.005), longer duration of jaundice (16 +/- 9 vs, 9 +/- 5 days; p = 0.03), and higher plasma levels of CCK (4.0 +/- 1.3 vs. 1.7 +/ - 1.0 pmol/L;p = 0.005), alanine aminotransferase (ALT) (226 +/- 209 vs. 18 7 +/- 161 UI/L; p = 0.01), endotoxin (15 +/- 10 vs. 6.5 +/- 7.0 EU/L; p = 0 .007), and TNF alpha (69 +/- 82 vs. 23 +/- 15 pg/ml; p = 0.008) than those without malnutrition. Hen-ever, only serum bilirubin, CCK! ALT, and patient age were predictors for malnutrition by multivariate analysis, Malnutritio n might be expected (95% confidence interval) in patients older than 68 yea rs with increased bilirubin (> 290 mmol/L) and ALT (> 210 UI/L) levels that corresponded with an OJMI > 55. It was concluded that nutritional alterati ons in patients with obstructive jaundice mere determined bg the intensity of the biliary obstruction correlated with increased plasma CCK levels as w ell as with liver dysfunction and patient age.