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. 2025 Feb 13;14(4):1220.
doi: 10.3390/jcm14041220.

Parenteral Nutrition-Induced Liver Function Complications: Incidence, Risk Factors, and Prognosis

Jae Woo Park  1 , Sun Ah Maeng  1 , Sang Gyune Kim  1 , Young Seok Kim  1 , Jeong-Ju Yoo  1
Affiliations

Parenteral Nutrition-Induced Liver Function Complications: Incidence, Risk Factors, and Prognosis

Jae Woo Park et al. J Clin Med. .

Abstract

Background/Objectives: Parenteral Nutrition-Associated Liver Disease (PNALD) is a significant complication in patients undergoing parenteral nutrition (PN). This study aims to explore the incidence, risk factors, and outcomes associated with PNALD, including abnormal liver function tests, in patients receiving parenteral nutrition, even in short-term PN recipients. Methods: A retrospective analysis of 500 patients receiving PN for at least 3 days at a tertiary medical center was conducted. Liver enzyme levels were monitored for 28 days, and PN duration, comorbidities, and metabolic factors were analyzed to identify independent risk factors of abnormal liver function tests and PNALD. Results: This study reported a 24.4% incidence of abnormal liver function tests and an 8.2% incidence of PNALD. Risk factors for abnormal liver function tests included liver disease (OR 2.064, 95% CI 1.224-3.479), infection (OR 1.654, 95% CI 1.075-2.546), PN duration (OR 1.035, 95% CI 1.014-1.056), and PN calories (OR 1.001, 95% CI 1.000-1.002). Significant PNALD risk factors comprised liver disease (OR 3.623, 95% CI 1.670-7.858), lung disease (OR 3.648, 95% CI 1.615-8.240), recent surgery (OR 3.719, 95% CI 1.645-8.407), PN duration (OR 1.041, 95% CI 1.016-1.068), total cholesterol (OR 1.005, 95% CI 1.000-1.010), and HDL-cholesterol (OR 1.012, 95% CI 1.001-1.023). The majority of PNALD cases (85.3%) showed improvement with PN modification or cessation. Conclusions: This study underscores that abnormal liver function tests and PNALD risks can emerge with short-term PN use. Identifying and addressing patient-specific risk factors is vital for predicting and preventing PNALD onset.

Keywords: abnormal liver function test; liver injury; parenteral nutrition; parenteral nutrition-associated liver disease.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier of Abnormal liver function test. Abnormal liver function tests occurred in 45 (40.1%) cases within 3 days, 31 (27.6%) cases between 3 and 7 days, 26 (23.2%) cases between 7 and 14 days, and 20 (17.8%) cases after 14 days.
Figure 2
Figure 2
Kaplan–Meier of PNALD accumulation. PNALD occurred in 6 (14.6%) cases within 3 days, 15 (36.5%) cases between 3 and 7 days, 11 (26.8%) cases between 7 and 14 days, and 7 (17.0%) cases after 14 days. PNALD, Parenteral Nutrition-Associated Liver Disease.
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