Parenteral nutrition in acute intestinal failure amongst the elderly was not associated with adverse clinical outcomes when compared to younger patients

Abstract

Introduction: Reported clinical outcomes for elderly patients with acute intestinal failure receiving parenteral nutrition (PN) in the acute hospital setting is limited. Our study aims to characterize the use of PN in the elderly and compare clinical outcomes against younger patients. Methods: A retrospective review of inpatients administered PN from 1st January 2019 to 31st December 2019 was performed. Demographics, indications for PN, biochemical results and clinical outcomes were compared. Patients were categorized into < 65 (younger) or ≥ 65 years old (elderly). Results: 235 patients were included. There were 103 patients in the elderly group with a mean age of 73.9 years (± 6.9 years) and 132 patients in the younger group with a mean age of 52.4 years (± 12.5 years). There was a significantly higher Charlson Comorbidity Index and comordities and lower Karnofsky score in the elderly group. Indications for PN were similar between both groups. There was more younger patients who required PN for ≥28 days. The elderly group received a significantly lower total calorie, dextrose and protein compared to the younger group (20.8 (7.8) vs 22.8 (6.3) kcal/kg/day ; 3.1 (1.4) vs 3.6 (1.4) g/kg/day ; 1.1 (0.4) vs 1.2 (0.3) g/kg/day ). Mean length of stay was significantly longer in the younger group than in the elderly group (59.8 (± 55.3 ) vs 35.9 (± 21.3) days). There was no significant difference in clinical outcomes: line sepsis, hypoglycemia, hyperglycemia, fluid overload, inpatient mortality and total mortality between the two groups. Conclusion: The usage of PN in elderly patients with acute intestinal failure was not associated with an increased rate of PN related complications nor worse clinical outcomes when compared with younger patients. and hence should not be denied when appropriate indications are present.