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4CPS-235 Parenteral nutrition-associated cholestasis as an early-onset adverse effect in adult patients
  1. P López-Méndez,
  2. F Fernández-Fraga,
  3. M Moreno-García,
  4. N Ibañez-Heras,
  5. T Molina-García
  1. Hospital Universitario de Getafe, Pharmacy Department, Madrid, Spain


Background Parenteral nutrition-associated cholestasis (PNAC) may occur in 25–100% of adult patients receiving long-term parenteral nutrition (PN).

Purpose To analyse the onset of PNAC in hospitalised adult patients and the possible risk factor associated.

Material and methods Observational, retrospective and longitudinal study that included adult patients who received PN for at least 5 days from January 2017 to September 2018 with normal serum level of alkaline phosphatase (AP), gamma-glutamyl traspeptidase (GGT) and total bilirrubin before starting PN. The primary endpoint was defined as time to the onset of cholestasis established as elevation in GGT (>106.6 U/L) or total bilirubin (>1.8 mg/dL) or AP (193.5 U/L) + (GGT or bilirrubin) that could not be explained by other causes. Possible risk factors were collected: gender, age and sepsis at initiation of PN, cyclic PN infusion, kcal/kg, balance between dextrose and fat and fat >1 g/kg/d at the onset of cholestasis or at the end of PN treatment in those patients who did not develop cholestasis. Statistical analysis was performed by Chi-square test for qualitative variables and student’s t-test for quantitative variables using STATA.

Results One-hundred and fifty-six patients were included. 48.7% of patients developed cholestasis within a median of 6 (IQR=4) days. The results of possible risk factors were:

Abstract 4CPS-235 Table 1

Conclusion PNAC is an adverse effect that not only happens in patients receiving long-term-PN, but also occurs in a high percentage of hospitalised adult patients receiving PN over the first week. In addition, males are associated with an increased likelihood for the development of PNAC, while cyclic PN infusion may be a protector factor for its onset.

References and/or acknowledgements No conflict of interest.

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