Parenteral fish oil improves outcomes in patients with parenteral nutrition-associated liver injury.

Abstract

OBJECTIVE:

The objective was to determine the safety and efficacy of a fish oil-based intravenous lipid emulsion (ILE) in the treatment of parenteral nutrition-associated liver disease (PNALD).

SUMMARY AND BACKGROUND DATA:

PNALD can be a lethal complication in children with short bowel syndrome (SBS). ILE based on soybean oil administered with parenteral nutrition (PN) may contribute to its etiology.

METHODS:

We performed an open-labeled trial of a fish oil-based ILE in 42 infants with SBS who developed cholestasis (serum direct bilirubin >2 mg/dL) while receiving soybean oil-based ILE. Safety and efficacy outcomes were compared with those from a contemporary cohort of 49 infants with SBS and cholestasis whose PN course included soybean ILE only. The primary efficacy end-point was time to reversal of cholestasis (direct bilirubin <=2 mg/dL).

RESULTS:

Three deaths and 1 liver transplantation occurred in the fish oil cohort, compared with 12 deaths and 6 transplants in the soybean oil cohort (P = 0.005). Among survivors not transplanted during PN, cholestasis reversed while receiving PN in 19 of 38 patients in the fish oil cohort versus 2 of 36 patients in the soybean oil cohort. Based on Cox models, subjects receiving fish oil-based ILE experienced reversal of cholestasis 6 times faster (95% CI: 2.0-37.3) than those receiving soybean oil-based ILE. The provision of fish oil-based ILE was not associated with hypertriglyceridemia, coagulopathy, or essential fatty acid deficiency. Moreover, hypertriglyceridemic events and abnormal international normalized ratio levels were more common among controls.

CONCLUSIONS:

Fish oil-based ILE is safe, may be effective in treating PNALD, and may reduce mortality and organ transplantation rates in children with SBS.

• Authors: Mark Puder, Clarissa Valim, Jonathan A Meisel, Hau D Le, Vincent E de Meijer, Elizabeth M Robinson, Jing Zhou, Christopher Duggan, Kathleen M Gura
• Journal: Annals of surgery (Ann Surg) Vol. 250 Issue 3 Pg. 395-402 (Sep 2009) ISSN: 1528-1140 [Electronic] United States
• PMID: 19661785 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Fat Emulsions, Intravenous
• Fish Oils
• Soybean Oil

Topics

• Cholestasis (etiology, therapy)
• Data Interpretation, Statistical
• Fat Emulsions, Intravenous (adverse effects, therapeutic use)
• Female
• Fish Oils (adverse effects, therapeutic use)
• Humans
• Infant
• Liver Function Tests
• Liver Transplantation (statistics & numerical data)
• Male
• Parenteral Nutrition (adverse effects, methods)
• Prospective Studies
• Short Bowel Syndrome (complications, therapy)
• Soybean Oil (adverse effects)
• Survival Rate
• Treatment Outcome