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A randomized clinical trial of supplementary parenteral nutrition in jaundiced alcoholic cirrhotic patients
Author(s) -
Naveau Sylvie,
Pelletier Gilles,
Poynard Thierry,
Attali Pierre,
Poitrine Alain,
Buffet Catherine,
Etienne JeanPierre,
Chaput JeanClaude
Publication year - 1986
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840060219
Subject(s) - parenteral nutrition , medicine , gastroenterology , spontaneous bacterial peritonitis , bilirubin , cholestasis , cirrhosis , surgery
Between March 1982 and September 1983, 40 inpatients (25 men and 15 women, mean age 53 years) with alcoholic cirrhosis and total serum bilirubin ⩾5 mg per dl were studied. Those with hepatocellular carcinoma, renal failure, hyponatremia, septicemia, spontaneous bacterial peritonitis, gastrointestinal bleeding, and hepatic coma were excluded. Patients were studied for 28 days. The two groups were offered an oral diet containing 40 kcal per kg per day. Patients in the supplementary parenteral nutrition group received 40 kcal per kg per day and 200 mg nitrogen per kg per day using a central catheter. The major endpoint was total serum bilirubin on Day 28. On admission, serum bilirubin was not significantly different in the two groups: oral group, 12.5 ± 6.6 mg per dl; supplementary parenteral nutrition group, 12.3 ± 8.5 mg per dl. On Day 28, serum bilirubin was lower in the supplementary parenteral nutrition group (2.5 ± 1.4 mg per dl) than in the oral group (4.1 ± 2.2 mg per dl) (p < 0.02). Serum bilirubin was also lower in the supplementary parenteral nutrition group than in the oral group on Days 7, 14and 21 (p < 0.05). Analysis of covariance, considering serum bilirubin on admission and at randomization and time between admission and randomization, confirmed these results. On Day 28, anthropometric parameters, serum transferrin, prealbumin and retinol‐binding protein were higherin the supplementary parenteral nutrition group, but the differences were not significant. Serum albumin was significantly lower in the supplementary parenteral nutrition group. The incidence of encephalopathy and sepsis was not significantly different between the two groups.