TY - JOUR
T1 - Prediction of chronic severe intestinal failure–associated liver disease by current criteria in adults
T2 - A descriptive cohort study
AU - Cipriano, Claudia
AU - Deutsch, Liat
AU - Kopczynska, Maja
AU - Rabinowich, Liane
AU - Sasdelli, Anna Simona
AU - Pironi, Loris
AU - Lal, Simon
N1 - Publisher Copyright:
© 2024 American Society for Parenteral and Enteral Nutrition.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
KW - adult
KW - home nutrition support
KW - life cycle
KW - liver disease
KW - long-term care
KW - nutrition
KW - parenteral nutrition
KW - research and diseases
UR - http://www.scopus.com/inward/record.url?scp=85213206086&partnerID=8YFLogxK
U2 - 10.1002/jpen.2719
DO - 10.1002/jpen.2719
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C2 - 39731261
AN - SCOPUS:85213206086
SN - 0148-6071
JO - Journal of Parenteral and Enteral Nutrition
JF - Journal of Parenteral and Enteral Nutrition
ER -