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BACKGROUND: Liverdysfunction associated with artificial nutrition in critically ill patients isa complication that seems to be frequent, but it has not been assessedpreviously in a large cohort of critically ill patients. METHODS: We conducteda prospective cohort study of incidence in 40 intensive care units. Differentliver dysfunction patterns were defined: (a) cholestasis: alkaline phosphataseof more than 280 IU/l, gamma-glutamyl-transferase of more than 50 IU/l, orbilirubin of more than 1.2 mg/dl; (b) liver necrosis: aspartateaminotransferase of more than 40 IU/l or alanine aminotransferase of more than42 IU/l, plus bilirubin of more than 1.2 mg/dl or international normalized ratioof more than 1.4; and (c) mixed pattern: alkaline phosphatase of more than 280IU/l or gamma-glutamyl-transferase of more than 50 IU/l, plus aspartateaminotransferase of more than 40 IU/l or alanine aminotransferase of more than42 IU/l. RESULTS: Seven hundred and twenty-five of 3,409 patients receivedartificial nutrition: 303 received total parenteral nutrition (TPN) and 422received enteral nutrition (EN). Twenty-three percent of patients developedliver dysfunction: 30% in the TPN group and 18% in the EN group. The univariateanalysis showed an association between liver dysfunction and TPN (p <0.001),Multiple Organ Dysfunction Score on admission (p <0.001), sepsis (p<0.001), early use of artificial nutrition (p <0.03), and malnutrition (p<0.01). In the multivariate analysis, liver dysfunction was associated withTPN (p <0.001), sepsis (p <0.02), early use of artificial nutrition (p<0.03), and calculated energy requirements of more than 25 kcal/kg per day(p <0.05). CONCLUSION: TPN, sepsis, and excessive calculated energyrequirements appear as risk factors for developing liver dysfunction. Septiccritically ill patients should not be fed with excessive caloric amounts,particularly when TPN is employed. Administering artificial nutrition in thefirst 24 hours after admission seems to have a protective effect.Leggil'articolo