{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T13:09:16Z","timestamp":1779887356655,"version":"3.53.1"},"reference-count":54,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T00:00:00Z","timestamp":1685664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Parenteral nutrition (PN) is often associated with liver dysfunction in the ICU, although other factors such as sepsis, acute heart failure (AHF), and hepatotoxic drugs can be equally present. The relative impact of PN on liver dysfunction in critically ill patients is largely unknown. Methods: We recorded the presence of pre-existing liver disturbances, AHF, sepsis, daily PN volume, and commonly used hepatotoxic drugs in adult ICU patients, together with daily aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), alkalic phosphatase (AP), total bilirubin (TB), and INR values in patients with three or more PN treatment days. A linear mixed-effects model was used to assess the relative contribution of each liver parameter. Nutritional adequacy was defined as intake\/needs. Results: We included 224 ICU patients with PN treatment lasting more than 3 days between 1 January 2017 and 31 December 2019. For AST, pre-existing liver disturbances (+180% \u00b1 11%) and the presence of AHF (+75% \u00b1 14%) were the main predictors of deterioration, whereas PN volume caused only a limited increase of 14% \u00b1 1%\/L. Similar results were observed for ALT. GGT, INR, and TB are mainly influenced by the presence of sepsis\/septic shock and pre-existing liver disturbances, with no impact of PN or hepatotoxic drugs. Carbohydrate intake exceeded recommendations, and protein and lipid intake were insufficient in this study cohort. Conclusions: Liver test disturbances in ICU patients on PN are multifactorial, with sepsis and AHF having the highest influence, with only limited impact from PN and hepatotoxic drugs. Feeding adequacy can be improved.<\/jats:p>","DOI":"10.3390\/nu15112612","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T08:50:31Z","timestamp":1685695831000},"page":"2612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Parenteral Nutrition, Sepsis, Acute Heart Failure and Hepatotoxic Drugs Are Related to Liver Test Disturbances in Critically Ill Patients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0182-6440","authenticated-orcid":false,"given":"Zenzi","family":"Rosseel","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium"},{"name":"Department of Clinical Nutrition, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3998-6586","authenticated-orcid":false,"given":"Pieter-Jan","family":"Cortoos","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium"},{"name":"Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7477-600X","authenticated-orcid":false,"given":"Joop","family":"Jonckheer","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium"},{"name":"Department of Intensive Care, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3458-0336","authenticated-orcid":false,"given":"Wilfried","family":"Cools","sequence":"additional","affiliation":[{"name":"Department of Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5115-8893","authenticated-orcid":false,"given":"Mathieu","family":"Vinken","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical and Pharmacological Sciences, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Reynaert","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium"},{"name":"Department of Gastro-Enterology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5126-3500","authenticated-orcid":false,"given":"Elisabeth","family":"De Waele","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium"},{"name":"Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium"},{"name":"Department of Intensive Care, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.clnu.2018.08.037","article-title":"ESPEN guideline on clinical nutrition in the intensive care unit","volume":"38","author":"Singer","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1056\/NEJMoa1409860","article-title":"Trial of the Route of Early Nutritional Support in Critically Ill Adults","volume":"371","author":"Harvey","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-017-1736-8","article-title":"A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: The TOP-UP pilot trial","volume":"21","author":"Wischmeyer","year":"2017","journal-title":"Crit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-014-0478-0","article-title":"Development and current use of parenteral nutrition in critical care\u2014An opinion paper","volume":"18","author":"Berger","year":"2014","journal-title":"Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-016-1538-4","article-title":"Resting energy expenditure, calorie and protein consumption in critically ill patients: A retrospective cohort study","volume":"20","author":"Zusman","year":"2016","journal-title":"Crit. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.clnu.2020.06.024","article-title":"Indirect calorimetry: The 6 main issues","volume":"40","author":"Achamrah","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"R10","DOI":"10.1186\/cc5670","article-title":"Liver dysfunction associated with artificial nutrition in critically ill patients","volume":"11","author":"Grau","year":"2007","journal-title":"Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/S1499-3872(12)60229-X","article-title":"Pathogenesis and treatment of parenteral nutrition-associated liver disease","volume":"11","author":"Xu","year":"2012","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5114\/ceh.2019.95528","article-title":"Review of parenteral nutrition-associated liver disease","volume":"6","year":"2020","journal-title":"Clin. Exp. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2009). EASL Clinical Practice Guidelines: Management of cholestatic liver diseases. J. Hepatol., 51, 237\u2013267.","DOI":"10.1016\/j.jhep.2009.04.009"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"547","DOI":"10.17219\/acem\/68363","article-title":"Liver dysfunction in sepsis","volume":"27","author":"Inglot","year":"2018","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1111\/j.1872-034X.2012.01069.x","article-title":"Sepsis-associated liver injury: Incidence, classification and the clinical significance","volume":"43","author":"Kobashi","year":"2012","journal-title":"Hepatol. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1007\/s11897-014-0206-8","article-title":"Cardiohepatic Syndrome: Liver Injury in Decompensated Heart Failure","volume":"11","author":"Laribi","year":"2014","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bj\u00f6rnsson, E.S. (2016). Hepatotoxicity by Drugs: The Most Common Implicated Agents. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17020224"},{"key":"ref_15","first-page":"104","article-title":"Drug-induced liber injury","volume":"16","author":"Dev","year":"2016","journal-title":"R. Collage Physicians"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1381\/0960892054621350","article-title":"Estimating Ideal Body Weight\u2014A New Formula","volume":"15","author":"Lemmens","year":"2005","journal-title":"Obes. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"i1585","DOI":"10.1136\/bmj.i1585","article-title":"Sepsis: Pathophysiology and clinical management","volume":"353","author":"Gotts","year":"2016","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1089\/sur.2017.278","article-title":"Sepsis 2018: Definitions and Guideline Changes","volume":"19","author":"Napolitano","year":"2018","journal-title":"Surg. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s11897-017-0351-y","article-title":"Acute Heart Failure: Definition, Classification and Epidemiology","volume":"14","author":"Kurmani","year":"2017","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1001\/jama.297.17.1883","article-title":"Levosimendan vs Dobutamine for Patients With Acute Decompensated Heart Failure","volume":"297","author":"Mebazaa","year":"2007","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1007\/s00204-018-2237-5","article-title":"Autophagy and acetaminophen-induced hepatotoxicity","volume":"92","author":"Shan","year":"2018","journal-title":"Arch. Toxicol."},{"key":"ref_22","first-page":"590","article-title":"Categorization of drugs implicated in causing liver injury: Critical assessment based on published case reports","volume":"63","author":"Hoofnagle","year":"2015","journal-title":"Hepatology"},{"key":"ref_23","first-page":"1279","article-title":"Alteraciones de los par\u00e1metros hep\u00e1ticos asociados con la administraci\u00f3n de utrici\u00f3n parenteral en pacientes adultos hospitalizados; incidencia y factores de riesgo","volume":"27","year":"2012","journal-title":"Nutr. Hosp."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jchf.2018.10.007","article-title":"Heart Failure and Liver Disease: Cardiohepatic Interactions","volume":"7","author":"Xanthopoulos","year":"2018","journal-title":"JACC Heart Fail."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1016\/S0002-9149(03)00370-9","article-title":"Liver dysfunction and heart failure","volume":"91","author":"Cogger","year":"2003","journal-title":"Am. J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/S0002-9149(02)02886-2","article-title":"Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation","volume":"90","author":"Lau","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1590\/S0066-782X2007000500015","article-title":"Clinical evaluation and hepatic laboratory assessment in individuals with congestive heart failure","volume":"88","author":"Vasconcelos","year":"2007","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1177\/014860719101500154","article-title":"Liver Function Tests in Patients Receiving Parenteral Nutrition","volume":"15","author":"Clarke","year":"1991","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_29","first-page":"30","article-title":"Chronic cholestasis and macronutrient excess in patients treated with prolonged parenteral nutrition","volume":"8","author":"Messing","year":"1992","journal-title":"Nutrition"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1177\/0148607191015003271","article-title":"Liver Dysfunction Associated with Long-Term Total Parenteral Nutrition in Patients with Massive Bowel Resection","volume":"15","author":"Ito","year":"1991","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/0016-5085(93)90864-9","article-title":"Special Reports and Reviews hepatobiliary complications of Total Parenteral Nutrition","volume":"104","author":"Quigley","year":"1993","journal-title":"Gastroenterology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.clnu.2005.01.001","article-title":"High serum phytosterol levels in short bowel patients on parenteral nutrition support","volume":"24","author":"Sunesson","year":"2005","journal-title":"Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1177\/0884533608321138","article-title":"Effect of Parenteral Serum Plant Sterols on Liver Enzymes and Cholesterol Metabolism in a Patient With Short Bowel Syndrome","volume":"23","author":"Hallikainen","year":"2008","journal-title":"Nutr. Clin. Pract."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/j.nut.2008.06.017","article-title":"Phytosterolemia in parenteral nutrition patients: Implications for liver disease development","volume":"24","author":"Llop","year":"2008","journal-title":"Nutrition"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3533","DOI":"10.1016\/j.clnu.2020.09.001","article-title":"ESPEN practical guideline: Clinical nutrition in liver disease","volume":"39","author":"Bischoff","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Cai, W., Calder, P.C., Cury-Boaventura, M.F., De Waele, E., Jakubowski, J., and Zaloga, G. (2018). Biological and Clinical Aspects of an Olive Oil-Based Lipid Emulsion\u2014A Review. Nutrients, 10.","DOI":"10.3390\/nu10060776"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1097\/MCC.0000000000000314","article-title":"Intravenous lipid emulsions in the critically ill","volume":"22","author":"Manzanares","year":"2016","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"De Waele, E., Malbrain, M.L., and Spapen, H. (2020). Nutrition in Sepsis: A Bench-to-Bedside Review. Nutrients, 12.","DOI":"10.3390\/nu12020395"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1177\/0884533611418783","article-title":"Comparison of the Effects of Different Intravenous Fat Emulsions in Patients With Systemic Inflammatory Response Syndrome and Sepsis","volume":"26","author":"Sungurtekin","year":"2011","journal-title":"Nutr. Clin. Pract."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Nagai, T., Honda, Y., Sugano, Y., Nishimura, K., Nakai, M., Honda, S., Iwakami, N., Okada, A., Asaumi, Y., and Aiba, T. (2016). Circulating Omega-6, But Not Omega-3 Polyunsaturated Fatty Acids, Are Associated with Clinical Outcomes in Patients with Acute Decompensated Heart Failure. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0165841"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/MCO.0000000000000253","article-title":"Lipid metabolism in critical illness","volume":"19","author":"Green","year":"2016","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1177\/0148607113518945","article-title":"A Randomized Controlled Trial Investigating the Effects of Parenteral Fish Oil on Survival Outcomes in Critically Ill Patients With Sepsis","volume":"39","author":"Hall","year":"2014","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"279","DOI":"10.3945\/an.114.007427","article-title":"Comparison of Formulas Based on Lipid Emulsions of Olive Oil, Soybean Oil, or Several Oils for Parenteral Nutrition: A Systematic Review and Meta-Analysis","volume":"7","author":"Dai","year":"2016","journal-title":"Adv. Nutr. Int. Rev. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1253\/circj.CJ-12-0875","article-title":"Low levels of serum n-3 polyunsaturated fatty acids are associated with worse heart failure-free survival in patients after acute myocardial infarction","volume":"77","author":"Hara","year":"2013","journal-title":"Circ. J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1161\/01.CIR.0000014682.14181.F2","article-title":"Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction","volume":"105","author":"Marchioli","year":"2002","journal-title":"Circulation"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Nishizaki, Y., Shimada, K., Tani, S., Ogawa, T., Ando, J., Takahashi, M., Yamamoto, M., Shinozaki, T., Miyazaki, T., and Miyauchi, K. (2016). Association between the docosahexaenoic acid to arachidonic acid ratio and acute coronary syndrome: A multicenter observational study. BMC Cardiovasc. Disord., 16.","DOI":"10.1186\/s12872-016-0299-y"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1177\/0885066619871452","article-title":"Multiple Organ Dysfunction Syndrome","volume":"35","author":"Gourd","year":"2019","journal-title":"J. Intensiv. Care Med."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"D\u2019angelo, S., Motti, M.L., and Meccariello, R. (2020). \u03c9-3 and \u03c9-6 Polyunsaturated Fatty Acids, Obesity and Cancer. Nutrients, 12.","DOI":"10.3390\/nu12092751"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0022-3468(98)90349-9","article-title":"New insight into mechanisms of parenteral nutrition\u2014Associated cholestasis: Role of plant sterols","volume":"33","author":"Iyer","year":"1998","journal-title":"J. Pediatr. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/0148607117722752","article-title":"Phytosterols Synergize With Endotoxin to Augment Inflammation in Kupffer Cells but Alone Have Limited Direct Effect on Hepatocytes","volume":"42","author":"Guthrie","year":"2017","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1177\/0148607113486006","article-title":"Parenteral fish oil lipid emulsions in the critically Ill","volume":"38","author":"Manzanares","year":"2013","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.clnu.2016.09.010","article-title":"Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group","volume":"36","author":"Barazzoni","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.clnesp.2019.08.009","article-title":"Incidence and risk factors of parenteral nutrition-associated liver disease in hospitalized adults: A prospective cohort study","volume":"34","author":"Lakananurak","year":"2019","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/j.jhep.2017.07.005","article-title":"Acetaminophen (APAP) hepatotoxicity\u2014Isn\u2019t it time for APAP to go away?","volume":"67","author":"Lee","year":"2017","journal-title":"J. Hepatol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/11\/2612\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:47:56Z","timestamp":1760125676000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/11\/2612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,2]]},"references-count":54,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["nu15112612"],"URL":"https:\/\/doi.org\/10.3390\/nu15112612","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,2]]}}}