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Open AccessArticle

Assessing Non-Invasive Liver Function in Patients with Intestinal Failure Receiving Total Parenteral Nutrition—Results from the Prospective PNLiver Trial

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Department of Gastroenterology and Hepatology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Department of Internal Medicine and Gastroenterology | Asklepios Klinik St. Georg, Asklepios Medical School, Lohmühlenstr. 5, 20099 Hamburg, Germany
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Department of General, Visceral and Vascular Surgery, Evangelisches Krankenhaus Paul Gerhardt Stift, Paul-Gerhardt-Str. 42-45, 06886 Lutherstadt Wittenberg, Germany
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Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany
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Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Rhine-Westphalia Institute of Technology, Pauwelsstraße 30, 52074 Aachen, Germany
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(5), 1217; https://doi.org/10.3390/nu12051217
Received: 28 March 2020 / Revised: 14 April 2020 / Accepted: 23 April 2020 / Published: 26 April 2020
(This article belongs to the Special Issue Contemporary Issues in Nutrition Research)
Liver abnormalities in intestinal failure (IF) patients receiving parenteral nutrition (PN) can progress undetected by standard laboratory tests to intestinal failure associated liver disease (IFALD). The aim of this longitudinal study is to evaluate the ability of non-invasive liver function tests to assess liver function following the initiation of PN. Twenty adult patients with IF were prospectively included at PN initiation and received scheduled follow-up assessments after 6, 12, and 24 months between 2014 and 2019. Each visit included liver assessment (LiMAx [Liver Maximum Capacity] test, ICG [indocyanine green] test, FibroScan), laboratory tests (standard laboratory test, NAFLD [non-alcoholic fatty liver disease] score, FIB–4 [fibrosis-4] score), nutritional status (bioelectrical impedance analysis, indirect calorimetry), and quality of life assessment. The patients were categorized post-hoc based on their continuous need for PN into a reduced parenteral nutrition (RPN) group and a stable parenteral nutrition (SPN) group. While the SPN group (n = 9) had significantly shorter small bowel length and poorer nutritional status at baseline compared to the RPN group (n = 11), no difference in liver function was observed between the distinct groups. Over time, liver function determined by LiMAx did continuously decrease from baseline to 24 months in the SPN group but remained stable in the RPN group. This decrease in liver function assessed with LiMAx in the SPN group preceded deterioration of all other investigated liver function tests during the study period. Our results suggest that the liver function over time is primarily determined by the degree of intestinal failure. Furthermore, the LiMAx test appeared more sensitive in detecting early changes in liver function in comparison to other liver function tests. View Full-Text
Keywords: intestinal failure; intestinal failure associated liver disease; parenteral nutrition; LiMAx test; ICG test; FibroScan intestinal failure; intestinal failure associated liver disease; parenteral nutrition; LiMAx test; ICG test; FibroScan
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Blüthner, E.; Pape, U.-F.; Stockmann, M.; Karber, M.; Maasberg, S.; Pevny, S.; Gerlach-Runge, U.; Pascher, A.; Pratschke, J.; Tacke, F.; Bednarsch, J. Assessing Non-Invasive Liver Function in Patients with Intestinal Failure Receiving Total Parenteral Nutrition—Results from the Prospective PNLiver Trial. Nutrients 2020, 12, 1217.

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