Management of Home Parenteral Nutrition: Complications and Survival

Abstract

<b><i>Background and Aims:</i></b> Parenteral nutrition (PN) has become an efficient, safe, and convenient treatment over years for patients suffering from intestinal failure. Home PN (HPN) enables the patients to have a high quality of life in their own environment. The therapy management however implies many restrictions and potentially severe lethal complications. Prevention and therapy of the latter are therefore of utmost importance. This study aims to assess and characterize the situation of patients with HPN focusing on prevalence of catheter-related complications and mortality. <b><i>Methods:</i></b> Swiss multicentre prospective observational study collecting demographic, anthropometric, and catheter-related data by means of questionnaires every sixth month from 2017 to 2019 (24 months), focusing on survival and complications. Data were analysed using descriptive statistics. Logistic regression models were fitted to investigate association between infection and potential co-factors. <b><i>Results:</i></b> Seventy adult patients (50% women) on HPN were included (≈5 patients/million adult inhabitants/year). The most common underlying diseases were cancer (23%), bariatric surgery (11%), and Crohn’s disease (10%). The most prevalent indication was short bowel syndrome (30%). During the study period, 47% of the patients were weaned off PN; mortality rate reached 7% for a median treatment duration of 1.31 years. The rate of catheter-related infection was 0.66/1,000 catheter-days (0.28/catheter-year) while the rate of central venous thrombosis was 0.13/1,000 catheter-days (0.05/catheter-year). <b><i>Conclusion:</i></b> This prospective study gives a comprehensive overview of the adult Swiss HPN patient population. The collected data are prerequisite for evaluation, comparison, and improvement of recommendations to ensure best treatment quality and safety.

Effect of home parenteral nutrition in malnourished patients

“…The eight percent mortality recorded in our observed set is comparable to the published 7 % (25). It is known that the risk of death increases with the duration of HPN application as well as with age above 75 years (17).…”

“…In the study of Ondrušová et al (27), in patients with SBS enrolled in HPN, the most common diagnoses were Crohn's disease (40 %) and non-neoplastic surgical conditions (25 %), and tumors (20 %). In the study by Reber et al (25), SBS was the cause for HPN in 30 % of patients. In a study by Fowarski et al (17), the most com-mon cause of HPN indication was malnutrition, intestinal diseases with intestinal malabsorption, post-procedural GIT conditions, and tumors.…”

“…In Switzerland, fi ve patients per 1 mil. inhabitants/1 year are reported on HPN (25), and in Poland, 53.26/1 mil. inhabitants/1 year (17).…”

“…The incidence of catheter thrombotic and infectious complications in published studies is reported to be 0.13-0.86 cases per 1000 catheter days (25,26,43). In patients with PN in intensive care units, the risk of catheter sepsis is signifi cantly higher (6.47 cases/1000 catheter days) and is associated with the length of hospitalization, length of PN, length of catheterization and its introduction, as well as procedures performed in the intensive care unit (44).…”

Cost-Effectiveness Analyses of Home Parenteral Nutrition for Incurable Gastrointestinal Cancer Patients

“…The prevalence of HPN was reported to be approximately 5–79 per million inhabitants per year in western countries, and 25% of patients suffered from malignant diseases ( 20 – 22 ). However, HPN is not a routinely recommended method of nutritional support in China considering its actual burdens despite China’s high incidence of gastrointestinal cancers, especially gastric cancer and liver cancer ( 23 ).…”