Clinical practice of nutrition in acute liver failure—a European survey

Background: Evidence-based guidelines for artificial nutrition in hyperacute (HLF), acute (ALF) and subacute liver failure (SLF) cannot be given at present due to scarcity of clinical studies. Methods: Current nutritional practice was surveyed using a questionnaire which was answered by 33 hepatology units (2–170 cases/year) in 11 European countries. Results: All units used specific nutrition support regimes in liver failure patients. Eight units (385 patients/year) preferentially used tube-feeding with standard diets, 25 units (377 patients/year) used parenteral nutrition (PN). For PN glucose was infused at 4.0 g/kg d (median; range 0.6–10.0). Intravenous fat was given only by some units: (18/33) in HLF at 0.9 g/kg d (0.3–2.0), (21/33) in ALF at 1.0 g/kg d (0.3–2.0), and (23/33) in SLF at 1.0 g/kg d (0.3–3.0). Amino acid solutions, predominantly enriched in branched-chain amino acids, were used in HLF (19/33 units) and in ALF (23/33) at 0.9 g/kg d (0.5–1.5) and in SLF (24/33) at 1.0 g/kg d (0.7–1.5). Conclusion: Hepatology units use a considerable variety of specific nutrition support strategies in liver failure. About 50% of patients receive enteral nutrition. Dosage and monitoring of PN is similar to other critical illness with a wide variety of infusion rates and accepted ranges of substrate plasma concentrations.