Safety and Tolerance on Lipids of Parenteral and Enteral Nutrition in Critically Ill Patients With Liver Failure (SELLIFA)

This study has been completed.
Sponsor:
Information provided by:
Cliniques universitaires Saint-Luc- Université Catholique de Louvain
ClinicalTrials.gov Identifier:
NCT00522730
First received: August 29, 2007
Last updated: September 2, 2009
Last verified: September 2009
  Purpose

The purpose of the study is to determine the tolerance on lipid metabolism and the safety of short-term parenteral nutrition as compared to enteral nutrition in critically ill patients with liver failure.


Condition Intervention Phase
Liver Failure
Critical Illness
Other: Parenteral nutrition
Other: Enteral nutrition
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Sepsis, Endothelial Function, and Lipids in Critically Ill Patients With Liver Failure (SELLIFA). Randomized Controlled Trial Comparing the Tolerance on Lipids and Safety of Isocaloric Parenteral Nutrition With Enteral Nutrition.

Resource links provided by NLM:


Further study details as provided by Cliniques universitaires Saint-Luc- Université Catholique de Louvain:

Primary Outcome Measures:
  • Change in plasma concentration of triglycerides, total cholesterol, HDL-cholesterol, free fatty acids, apolipoproteins, lipoprotein (a) [ Time Frame: within 5 days ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Incidence of hyperglycaemia [ Time Frame: within 5 days ] [ Designated as safety issue: Yes ]
  • Alteration of liver function [ Time Frame: within 5 and 28 days ] [ Designated as safety issue: Yes ]
  • Gastrointestinal intolerance [ Time Frame: within 5 days ] [ Designated as safety issue: No ]
  • Gastrointestinal bleeding [ Time Frame: within 5 and 28 days ] [ Designated as safety issue: Yes ]
  • Septic complications [ Time Frame: within 5 and 28 days ] [ Designated as safety issue: Yes ]
  • Occurence of new organ dysfunction [ Time Frame: within 5 and 28 days ] [ Designated as safety issue: Yes ]
  • Length of stay in the intensive care unit (ICU) [ Time Frame: within 5 and 28 days ] [ Designated as safety issue: No ]
  • Mortality [ Time Frame: within 5 and 28 days ] [ Designated as safety issue: No ]

Enrollment: 45
Study Start Date: August 2007
Study Completion Date: August 2009
Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
Parenteral nutrition
Other: Parenteral nutrition
Duration : 5 days
Active Comparator: 2
Enteral nutrition
Other: Enteral nutrition
Duration : 5 days

Detailed Description:

An impaired lipid metabolism is often found in patients with liver disease and is assumed to influence the prognosis. The central role of lipid metabolism in the pathophysiology of fatty liver disease and steatohepatitis is well established. In cirrhotic patients, serum lipid levels are mostly decreased and related to the severity of liver failure; in addition, the structure and composition of lipoproteins differ from that of healthy individuals. A reduction in high-density lipoproteins has been associated with higher cytokines levels and a poorer clinical outcome in septic patients. Furthermore, the oxidative stress induced by septic complications in critically ill patients with liver failure may lead to further hepatocellular injury and activation of systemic inflammation cascade.

In this setting, the influence of nutrition on lipid metabolism may have an impact on the severity of liver failure and associated complications. Although plasma clearance and oxidation of lipids were considered to be normal in the majority of patients with cirrhosis, most previous studies only reported the effects of an oral ingestion or parenteral infusion of lipids during a few hours.

The present randomized controlled trial will be conducted in a subgroup of patients enrolled in the SELLIFA-01 prospective study (NCT00488917). The purpose of the nutritional trial is to determine the tolerance on lipid metabolism and the safety of isocaloric short-term parenteral nutrition as compared to enteral nutrition in critically ill septic and non septic patients with liver failure. The nutrition will be delivered continuously for 5 days and will provide a daily energy supply corresponding to current resting energy expenditure as determined by indirect calorimetry, with 35% of total energy requirements as lipids, 15% as proteins (maximum 1.2g/kg ideal body weight/day), and 50% as dextrose. A tight glucose control strategy will be implemented to avoid hyperglycemia.

The trial is designed to randomly assign 15 patients in each interventional group in order to detect more than 25% increase in plasma triglycerides levels with 80% statistical power for two-tailed type I error of 5%.

  Eligibility

Ages Eligible for Study:   18 Years to 85 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • All consecutive patients with a diagnosis of chronic liver failure;
  • Planned total nutritional support;
  • Adult patient aged 18 years or above, and less than 85;
  • Admission to the ICU for an expected period of > 24 hours;
  • Informed consent of the patient or nearest relative.

Exclusion Criteria:

  • Absolute contra-indications to enteral nutrition : total mechanical ileus, persistent vomiting, high output fistulas, uncertain gastrointestinal anastomosis;
  • Absolute contra-indications to parenteral nutrition : severe hypertriglyceridemia > 6 mmol/l (> 545 mg/dL), severe diabetic ketoacidosis;
  • Age less than 18 years or more than 85;
  • Pregnancy, including HELLP syndrome;
  • Active malignancy with metastases (localized hepatocellular carcinoma is not an exclusion criteria);
  • Systemic chemotherapy in the last 4 weeks (trans-arterial chemo-embolisation for localized hepatocellular carcinoma is not an exclusion criteria);
  • Acquired immunodeficiency syndrome and antiretroviral therapy;
  • Refusal of the patient or nearest relative.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00522730

Locations
Belgium
Departement of intensive care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain
Brussels, Belgium, 1200
Sponsors and Collaborators
Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Investigators
Study Director: Pierre-François Laterre, MD Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Principal Investigator: Yvan Fleury, MD Cliniques universitaires Saint-Luc- Université Catholique de Louvain
  More Information

No publications provided

Responsible Party: Pierre-François Laterre, MD, Cliniques universitaires Saint-Luc, Université Catholique de Louvain
ClinicalTrials.gov Identifier: NCT00522730     History of Changes
Other Study ID Numbers: SELLIFA-02, B40320072194, EudraCT n°2007-002940-86
Study First Received: August 29, 2007
Last Updated: September 2, 2009
Health Authority: Belgium: Institutional Review Board
Belgium: Federal Agency for Medicinal Products and Health Products

Keywords provided by Cliniques universitaires Saint-Luc- Université Catholique de Louvain:
Liver failure
Liver cirrhosis
Parenteral nutrition
Enteral nutrition
Lipids
Safety
Drug tolerance

Additional relevant MeSH terms:
Critical Illness
Liver Failure
Digestive System Diseases
Disease Attributes
Hepatic Insufficiency
Liver Diseases
Pathologic Processes

ClinicalTrials.gov processed this record on October 30, 2014