Liver disease is frequent in patients taking
home parenteral nutrition (HPN), but its cause remains unclear. Ongoing
inflammation was implicated in HPN-associated
cholestasis, so we examined the relation between liver-
enzyme concentrations and circulating inflammatory and
immune markers in these patients. In 17 HPN patients and 10 age- and sex-matched control subjects, we examined erythrocyte sedimentation rate, blood
neopterin, soluble
interleukin (IL)--2 receptors, circulating
tumor necrosis factor-alpha,
IL-6,
aspartate and
alanine aminotransferases, alkaline
phosphatases, and gamma-glutamyltranspeptidase (GGT) concentrations. Fourteen of 17 patients had abnormal liver function tests with an increase in alkaline
phosphatases (P < 0.001), gamma-glutamyltranspeptidase (P < 0.01), and
aspartate aminotransferase (P < 0.01). Alkaline
phosphatases were positively correlated to erythrocyte sedimentation rate,
neopterin,
tumor necrosis factor-alpha, and
IL-6. gamma-Glutamyltranspeptidase was positively linked to
tumor necrosis factor-alpha and soluble
IL-2 receptors. There was no link between
aminotransferases and inflammatory parameters. Liver-
enzyme concentrations were correlated to the amount of total intravenous calories and calories originating from
carbohydrates but not to infused
lipids (median infused
lipids x kg(-1)
body weight x d(-1) = 0.62 g) in contrast to recently published data. Our results confirmed that the number of infused calories contributes to liver toxicity in HPN patients and strongly suggested that sustained
inflammation is probably a key factor in worsening HPN-associated
cholestasis.