Lipid-Free PN is Associated with an Increased Risk of Hyperbilirubinemia in Surgical Critically Ill Patients with Admission Hepatic Disorder: A Retrospective Observational Study

Shih-Chi Wu,1,2,&ast; Te-An Chen,3,&ast; Han-Tsung Cheng,3 Yu-Jun Chang,4 Yu-Chun Wang,3 Chia-Wei Tzeng,3 Chia-Hao Hsu,3 Chih-Hsin Muo5 1School of Medicine, China Medical University, Taichung, Taiwan; 2Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan; 3Department of Surgery, China Medical University Hospital, Taichung, Taiwan; 4Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan; 5Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan&ast;These authors contributed equally to this workCorrespondence: Shih-Chi WuTrauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 404, TaiwanTel +886-4-22052121 ext. 5043Fax +886-4-22334706Email rw114@mail.cmuh.org.twBackground: To evaluate the effect of different PN types on surgical critically ill trauma/acute care surgery patients with hepatic disorders at admission.Methods: This is a retrospective study. The PN types included lipid-free, soybean oil/medium-chain triglyceride, olive oil-based, and fish oil-containing PNs. Patients admitted with liver injury or liver surgery, elevated serum AST/ALT level, and elevated serum total bilirubin level were included. The exclusion criteria are as follows: 1) age < 18 years, 2) severe liver disease/cirrhosis, 3) received more than one type of PN and 4) serum total bilirubin > 4.9 mg/dl at admission. Demographics, severity, comorbidities, blood stream infection, hyperbilirubinemia (total bilirubin > 6.0 mg/dl), and mortality were collected for analysis. We also performed analysis stratified by separated lipid doses (g/kg/day).Results: A total of 156 patients were enrolled. There were no demographic differences among groups. The lipid-free group was associated with the highest mortality rate and incidence of hyperbilirubinemia. Compared to the lipid-free group, the olive oil-based group had the lowest risk of hyperbilirubinemia. After being stratified by separated lipid doses, the incidence of hyperbilirubinemia decreased when the lipid dosage increased. Regarding different types of lipids, patients who received more than the median dosage of lipids showed a significantly lower risk of hyperbilirubinemia, except in the fish oil-containing group.Conclusion: Our result suggested that lipid-free PN is associated with an increased risk of hyperbilirubinemia in surgical critically ill patients with admission hepatic disorder. Further studies are warranted.Keywords: hyperbilirubinemia, intravenous fat emulsion, parenteral nutrition, surgical critically ill