Parenteral Lipid Emulsions and the Liver Function

Stanley Dudrick's Memorial Hospital64 enrolled

Overview

The randomized, double-blind, multi-centric study performed in four parallel groups to compare all lipid emulsions, which can be used as a part of PN. Patients with home parenteral nutrition due to stable intestinal failure, were randomly assigned to receive parenteral nutrition with one the following lipid emulsions: * Long-chained triglycerides (LCT group) * Medium/ long-chained triglycerides MCT/LCT (50:50, MCT/LCT group)) * Olive oil/ LCT (80:20, OO group)) * SMOFlipid (Omega-3/ olive oil/ MCT/ LCT, SMOF group)

Intravenous lipid emulsion (IVLE) is the essential component of parenteral nutrition (PN), because it is a very efficient source of energy and essential fatty acids (FA).The prevalence of abnormal liver function tests during PN varies from 15 to 85%, according to most authors.\[19-21\] The severity of IFALD depends also on underlying disease, especially ongoing sepsis and pre-existing liver disease. A study comparing all lipid emulsions, which can be used as a part of PN, has never been done. The aim of the study was to compare the clinical value of the four most popular intravenous lipid emulsions in regards to the liver function in long term intestinal failure patients.Patients with home parenteral nutrition due to stable intestinal failure, were randomly assigned to receive parenteral nutrition with one the following lipid emulsions: * Long-chained triglycerides (LCT group) * Medium/ long-chained triglycerides MCT/LCT (50:50, MCT/LCT group)) * Olive oil/ LCT (80:20, OO group)) * SMOFlipid (Omega-3/ olive oil/ MCT/ LCT, SMOF group) Randomization was performed after assessment and check for in-/exclusion criteria if the patient has met all study eligibility requirements. The test emulsion became a part of regular PN admixture, which was used to feed patient at home. The study was performed for 12 months.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

Conditions

Liver Failure

Interventions

Lipid Emulsions, IntravenousDRUG

The every day provision of lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. chronic intestinal failure (CIF) receiving HPN including lipids 2. metabolic stability on HPN for more than three months (metabolic stability = the absence of pathological laboratory resulting in the change of PN regime for at least one month) 3. 1.0 g lipids/kg body weight per day as a part of PN Exclusion Criteria: 1. Existing liver failure: an elevation of SGOT, SGTP, total bilirubin, GGTP, alkaline phosphatase of more than 1.5 times x normal value 2. Patients in whom PN was interrupted for longer than 4 continuous weeks in the preceding 6 months 3. Patients with history of cancer and anti-cancer treatment within the last 5 years 4. Severe hyperlipidemia 5. Severe coagulopathy 6. Severe renal insufficiency 7. Acute thromboembolic events 8. Positive test for HIV, Hepatitis B or C (from medical history) 9. Known or suspected drug or alcohol abuse 10. Participation in another interventional clinical trial in parallel or within three months prior to the start of this clinical trial 11. For women with childbearing potential (i.e. females who are not chemically or surgically sterile or females who are not postmenopausal) or women of childbearing potential tested positive on standard pregnancy test (urine dipstick) or/ and lactation

Locations (1)

Stanley Dudrick's Memorial Hospital

Skawina, Poland

Outcomes

Primary Outcomes

Liver function

Measurement of bilirubin - at the beginning and every three months up to 12 months

Time frame: 12 months

Secondary Outcomes

Liver function 2

Measurement of SGTP - at the beginning and every three months up to 12 months

Time frame: 12 months

Liver function 3

Measurement of SGOT - at the beginning and every three months up to 12 months

Time frame: 12 months

Liver function 4

Measurement of GGTP - at the beginning and every three months up to 12 months

Time frame: 12 months

Liver function 5

Measurement of alkaline phosphatase - at the beginning and every three months up to 12 months

Time frame: 12 months

Data from ClinicalTrials.gov

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