Effect of total parenteral nutrition on hepatic histology
B. M. Wolfe, B. K. Walker, D. B. Shaul, L. Wong and B. H. Ruebner
Department of Surgery, University of California, Davis, Medical Center, Sacramento 95817.
We evaluated the effect of total parenteral nutrition (TPN) on
abnormalities of hepatic histology. Liver biopsies of 93 patients who were
concurrently receiving TPN were compared with a control group of 35
patients. The control patients were matched for extent of preexisting liver
disease and degree of illness. The liver biopsy specimens were blindly
graded on 19 histopathologic findings, including fatty change, portal
inflammation, and cholestasis. Twenty-seven clinical variables, such as
preexisting liver disease, the presence or absence of sepsis or shock, and
number of days receiving TPN before biopsy, were recorded. Individual and
partial correlations were established between the clinical variables and
histopathologic findings. The control and TPN groups proved to have been
closely matched regarding the extent of risk factors for hepatic
histopathologic features. Positive correlations were repeatedly found
between abnormal hepatic histologic features and preexisting liver disease,
abdominal sepsis, renal failure, and blood transfusion but not with the
administration of TPN. We conclude that clinical phenomena, such as
existing liver disease, renal failure, and abdominal sepsis, rather than
administration of TPN, had a predominant effect on histopathologic features
in this group of patients.