Prediction of chronic severe intestinal failure–associated liver disease by current criteria in adults: A descriptive cohort study

Claudia Cipriano*, Liat Deutsch, Maja Kopczynska, Liane Rabinowich, Anna Simona Sasdelli, Loris Pironi, Simon Lal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Intestinal failure–associated liver disease covers a spectrum of conditions from mild to end-stage disease. Currently, there are 9 diagnostic criteria divided to four categories: cholestasis, steatosis, fibrosis, and unclassified. Our aim was to evaluate the application of these criteria to patients with chronic severe liver disease in patients with intestinal failure. Methods: This was a cross-sectional study of patients attending the home parenteral nutrition clinic of a national UK reference intestinal failure center from March 2015 to December 2019. Exclusion criteria included active malignancy, home parenteral nutrition for <6 months duration, and liver transplantation. Clinically significant intestinal failure–associated liver disease was defined as moderate-severe fibrosis or cirrhosis on liver biopsy and/or radiological imaging compatible with liver cirrhosis. Results: Two hundred and twenty-one patients were included (age at home parenteral nutrition initiation: 50 ± 16.0 years; 63.6% female). There was a wide range of intestinal failure–associated liver disease point prevalence depending on the established criteria used (2.9%–35.1%). Twenty-three patients (9.5%) were diagnosed with clinically significant intestinal failure–associated liver disease, but no patient with clinically significant intestinal failure–associated liver disease met all diagnostic criteria, and 6 of 23 (26.1%) did not fit any of the established criteria. Conclusions: Intestinal failure–associated liver disease is a poorly defined medical condition, and current noninvasive diagnostic methods are unreliable in predicting disease severity. Further studies are needed to develop the definition to reflect that intestinal failure–associated liver disease is a spectrum of disease that includes chronic severe liver disease and improve methods of disease diagnosis.

Original languageEnglish
JournalJournal of Parenteral and Enteral Nutrition
DOIs
StateAccepted/In press - 2024

Keywords

  • adult
  • home nutrition support
  • life cycle
  • liver disease
  • long-term care
  • nutrition
  • parenteral nutrition
  • research and diseases

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