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Evaluation of Fibrosis in Intestinal Failure–Associated Liver Disease in the Sustain Registry
Author(s) -
Wang Jennifer,
Wamuo Obinnaya,
Micic Dejan
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1758
Subject(s) - medicine , odds ratio , fibrosis , gastroenterology , short bowel syndrome , confidence interval , intestinal failure , liver disease , parenteral nutrition
Abstract Background Intestinal failure–associated liver disease (IFALD) is one of the leading complications in type III intestinal failure (IF). Early recognition of liver‐fibrosis development in IFALD is crucial to the development of strategies aimed at reducing the risk of complications secondary to IFALD. Our aim was to identify patients with advanced fibrosis using a noninvasive index and to study the risk factors for fibrosis development in the Sustain registry. Methods Using the Sustain registry, patients requiring >3 months of parenteral nutrition (PN) support were identified. The presence or absence of advanced fibrosis was identified using the Fibrosis‐4 (FIB‐4) index. Risk factors for the presence of a high FIB‐4 score were identified using univariable logistic regression. Results Two hundred seventy‐one adult patients were included. Sixty‐three patients (23.2%) were at risk for advanced fibrosis based on the FIB4‐index. Risk factors for advanced fibrosis included short‐bowel syndrome (odds ratios [ORs]: 1.84; 95% confidence interval [CI], 1.03–3.28), receipt of PN for >1 year (OR: 2.6; 95% CI, 1.46–4.64), receipt of PN for >5 years (OR: 3.05; 95% CI, 1.67–5.59), and days of lipid emulsion use (OR: 1.11; 95% CI, 1–1.24). Small‐intestine–remnant length was inversely associated with advanced fibrosis (OR: 0.97, 95% CI, 0.95–0.99). Conclusion Advanced fibrosis, as guided by FIB‐4 index, is associated with known risk factors for IFALD. Therefore, the FIB‐4 index is potentially a useful noninvasive tool for identification of individuals at risk for fibrosis in IFALD. Further studies utilizing a gold‐standard fibrosis assessment will be required to validate these results.