Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure

Abstract

Background and aimNo marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity.MethodsAt baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1–2, 2–3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI).ResultsFifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN >3 L/day).ConclusionsThe type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.

Patients With Severe Gastrointestinal Dysmotility Disorders Receiving Home Parenteral Nutrition Have Similar Survival As Those With Short‐Bowel Syndrome: A Prospective Cohort Study

“…However, the participating programs are academic centers, where it is expected that diagnoses and management of GID follow recommended pathways and guidelines 6,7,15 . We did not look into intravenous fluid supplement types or volume, which may have a prognostic factor in patients with chronic intestinal failure 25 . However, we evaluated HPN dependence in our cohort, an indirect surrogate marker for the severity of chronic failure, and it showed to be a risk factor for mortality in both GID and SBS patients.…”

Characteristics of adult patients with chronic intestinal failure due to short bowel syndrome: An international multicenter survey

“…The ESPEN international cross-sectional observational study on CIF [3] was the baseline of a prospective survey developed by the Home Artificial Nutrition and Chronic Intestinal Failure (HAN&CIF) special interest group of ESPEN, aimed at investigating the outcome of patients with CIF [9]. Invitation to participate in the study occurred via representatives of the national Parenteral and Enteral Nutrition (PEN) societies of the ESPEN Council, who were asked to send the study protocol to members of their PEN societies.…”

Considerations for the management of home parenteral nutrition during the SARS-CoV-2 pandemic: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN

“…Patients with chronic (type 3) intestinal failure (CIF) require long term home HPN to sustain life [8,10]. CIF care is often centralised regionally or nationally in different countries in order to concentrate clinical expertise and improve patient outcomes [11]. This care is best delivered by a multi-disciplinary IF team [8] with routine follow-up consisting of laboratory as well as in-person assessment.…”