This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Buchman, A. L. Articles by Ahn, C. Search for Related Content PubMed PubMed Citation Articles by Buchman, A. L. Articles by Ahn, C. Social Bookmarking                   What's this?

Choline Deficiency Is Associated With Increased Risk for Venous Catheter Thrombosis

Alan L. Buchman, MD, MSPH^*, Marvin E. Ament, MD, Donald J. Jenden, BSc and Chul Ahn, PhD

From the ^* Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Pediatric Gastroenterology, Geffen School of Medicine, University of California, Los Angeles, California; Division of Pharmacology, Geffen School of Medicine, University of California, Los Angeles, California; and the Department of Medicine, University of Texas, Houston, Texas

Correspondence: Alan L. Buchman, MD, MSPH, 676 N. St. Clair St., Suite 1400, Chicago, IL 60611. Electronic mail may be sent to a-buchman{at}northwestern.edu.

Background: Patients with intestinal failure who require long-term parenteral nutrition (PN) develop catheter thrombosis as a complication. This patient group may also develop choline deficiency because of a defect in the hepatic transsulfuration pathway in the setting of malabsorption. This study was undertaken to determine whether choline deficiency is a risk factor for development of catheter thrombosis. Methods: Plasma free and phospholipid-bound choline concentrations were measured in a group of 41 patients that required long-term PN. Episodes of catheter thrombosis from onset of PN to the time of blood testing were recorded. Results: Sixteen (39%) patients developed catheter thrombosis, and 5 of these had recurrent catheter thrombosis. Plasma free choline was 7.7 ± 2.7 nmol/mL in patients with no history of catheter thrombosis and 6.2 ± 1.7 nmol/mL in patients with previous catheter thrombosis (p = .076 by Wilcoxon rank-sum test). The partial correlation between plasma free choline concentration and the frequency of clots after controlling for catheter duration was r = –0.33 (p = .038). The relative risk for catheter thrombosis in subjects with a plasma free choline concentration <8 nmol/mL was 10.0, 95% confidence interval (1.134–88.167). Plasma phospholipid-bound choline concentration was 2191.7 ± 679.0 nmol/mL in patients with previous catheter thrombosis and 2103.3 ± 531.2 nmol/mL in patients without history of catheter thrombosis (p = NS). Conclusion: Choline deficiency is a significant risk factor for development of catheter thrombosis in patients with intestinal failure who require PN.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?