Thrombotic and Infectious Risks of Parenteral Nutrition in Hospitalized Pediatric Inflammatory Bowel Disease

Abstract

Background: Malnutrition is common in inflammatory bowel disease (IBD), requiring timely and sufficient nutritional supplementation. In patients hospitalized for active disease, symptoms and/or altered intestinal function hinder enteral nutrition feasibility. In this scenario, parenteral nutrition (PN) is used. We aimed (1) to assess the frequency of PN use between 1997 and 2012 among hospitalized pediatric patients with IBD, (2) to determine the risk of in-hospital thrombus and infection associated with PN, and (3) to identify predictors of thrombus and infection in pediatric IBD hospitalizations utilizing PN. Methods: We performed a cross-sectional analysis of pediatric patients hospitalized between 1997 and 2012. We used the Kids' Inpatient Database (KID) to identify pediatric patients (≤18 years of age) with Crohn's disease (CD) or ulcerative colitis (UC), PN exposure, and primary outcomes including thrombus and infection. We used multivariable regression to identify risk factors for outcomes of interest. Results: Parenteral nutrition was utilized in 3732 (12%) of 30,914 IBD hospitalizations. Three percent of PN patients experienced a thrombotic complication, and 5.5% experienced an infectious complication. Multivariate analysis showed PN as an independent risk factor for thrombus (odds ratio [OR], 4.3; 95% confidence interval [CI], 3.2-5.6) and infection (OR, 3.8; 95% CI, 3.1-4.6). Surgery was an independent risk factor for thrombus (OR, 2.0; 95% CI, 1.4-2.7) and infection (OR, 2.5; 95% CI, 2.0-3.1) in hospitalizations exposed to PN. Conclusions: Hospitalized pediatric IBD patients, particularly surgical, receiving PN are at increased risk for thrombosis and infection. Clinicians must balance these risks with the benefits of PN.

Inflammatory Bowel Disease and Thrombosis: A National Inpatient Sample Study

“…Thrombosis-specific risk factors, including steroid use, malnutrition, dehydration, port use, abdominal surgery, and general surgery, were all significantly more common in IBD than non-IBD thrombosis patients, consistent with previous studies. 10,[16][17][18][19][20][21] Malnutrition was likely associated with other risks for VTE, including requirement for port/central venous catheter, hospitalization, and/or surgery. 19 Further, women with IBD, similar to those without IBD, were significantly more likely than men to develop thrombosis, as previously reported, consistent with thrombosis risk in pregnancy and in the postpartum period.…”

“…10,[16][17][18][19][20][21] Malnutrition was likely associated with other risks for VTE, including requirement for port/central venous catheter, hospitalization, and/or surgery. 19 Further, women with IBD, similar to those without IBD, were significantly more likely than men to develop thrombosis, as previously reported, consistent with thrombosis risk in pregnancy and in the postpartum period. 22,23 Asian ethnicity was found to be protective, consistent with general risk of thromboembolism in this group.…”

Nutritional approach as therapeutic manipulation in inflammatory bowel disease

“…Additionally, there were no significant differences in the remission rate between TPN and EN [48]. TPN is rather expensive, with infection and thromboembolism due to venous catheter and hepatobiliary complication being considered independent risk factors [49,50]. TPN is ineffective in treating patients with severe UC [43,46].…”

Significance of nutritional treatment for patients with inflammatory bowel disease in the era of biologics

“…Greenberg et al [106] compared the effects of TPN, partial parenteral with CD [107] . When comparing TPN and EN, TPN is associated with higher costs and significant risks such as infection and should be restricted to patients who cannot take adequate nutrition enterally [108,109] .…”