Francisca Joly1, Janet Baxter2, Michael Staun3, Darlene G Kelly4, Yi Lisa Hwa4, Olivier Corcos5, Antonella De Francesco6, Federica Agostini7, Stanislaw Klek8, Lidia Santarpia9, Franco Contaldo9, Cora Jonker10, Geert Wanten11, Luisa Chicharro12, Rosa Burgos12, Andre Van Gossum13, Cristina Cuerda14, Nuria Virgili15, Loris Pironi7. 1. Department of Gastroenterology and Nutritional Support, Hospital Beaujon - University Paris VII, France. Electronic address: francisca.joly@bjn.aphp.fr. 2. Nutrition and Dietetic Service, NHS Tayside, Dundee, UK. 3. Department of Medical Gastroenterology CA, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. 4. Mayo Clinic Rochester, St. Mary's and Methodist Hospitals, Rochester, MN, 55905, USA. 5. Department of Gastroenterology and Nutritional Support, Hospital Beaujon - University Paris VII, France. 6. Dietetic and Clinical Nutrition, Città della Salute e della Scienza di Torino, Italy. 7. Chronic Intestinal Failure Center, St. Orsola-Malpighi Hospital, University of Bologna, Italy. 8. Nutrimed Medical Center, Krakow, Poland. 9. Federico II University Naples, Italy. 10. Academic Medical Centre, Amsterdam, The Netherlands. 11. Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands. 12. Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron, Barcelona, Spain. 13. Hopital Erasme, 808 Route de Lennick 1070, Brussels, Belgium. 14. Hospital General Universitario Gregorio Marañón, Madrid, Spain. 15. Nuria Virgili, Hospital Universitari de Bellvitge, L'Hospitalet de llobregat, Spain.
Abstract
BACKGROUND & AIM: Home parenteral nutrition (HPN) is the primary treatment for chronic intestinal failure (IF). Intestinal transplantation (ITx) is indicated when there is an increased risk of death due to HPN complications or to the underlying disease. Age, pathophysiologic conditions and underlying disease are known predictors of HPN dependency and overall survival. Although the cause of death on HPN is mostly related to underlying disease in these patients, the relationship between mortality and duration of HPN use remains unclear. The purpose of the present study is to describe factors associated with survival and HPN dependency as well as causes of death in adult patients requiring HPN for chronic intestinal failure during the first 5 years of treatment with HPN. METHODS: A multicenter international (European and USA) questionnaire-based retrospective follow-up of a cohort of 472 IF patients who started HPN was conducted between June and December 2000. Study endpoint was either end of 5-year follow-up, weaned-off HPN, ITx, or death on HPN. Data were analyzed for HPN dependence and overall survival using Kaplan-Meier models and log rank tests. RESULTS: The overall survival probability was 88%, 74% and 64% at 1, 3 and 5 years respectively. Survival was inversely related to age (p < .001) and higher in patients with Crohn's disease or chronic idiopathic pseudo-obstruction. A total of 169 (36.5%) patients were weaned-off HPN mainly (80%) within the first year and most frequently in patients with fistulae. Five of the 14 patients who underwent ITx died. By the end of the study, 104 (23%) of patients died on HPN; 65% of deaths occurred within the first 2.5 years of HPN. CONCLUSIONS: Younger ages at HPN initiation and underlying pathologies are significantly predictive of survival on HPN. Risk of death is greatest during the first 2 years of HPN.
BACKGROUND & AIM: Home parenteral nutrition (HPN) is the primary treatment for chronic intestinal failure (IF). Intestinal transplantation (ITx) is indicated when there is an increased risk of death due to HPN complications or to the underlying disease. Age, pathophysiologic conditions and underlying disease are known predictors of HPN dependency and overall survival. Although the cause of death on HPN is mostly related to underlying disease in these patients, the relationship between mortality and duration of HPN use remains unclear. The purpose of the present study is to describe factors associated with survival and HPN dependency as well as causes of death in adult patients requiring HPN for chronic intestinal failure during the first 5 years of treatment with HPN. METHODS: A multicenter international (European and USA) questionnaire-based retrospective follow-up of a cohort of 472 IF patients who started HPN was conducted between June and December 2000. Study endpoint was either end of 5-year follow-up, weaned-off HPN, ITx, or death on HPN. Data were analyzed for HPN dependence and overall survival using Kaplan-Meier models and log rank tests. RESULTS: The overall survival probability was 88%, 74% and 64% at 1, 3 and 5 years respectively. Survival was inversely related to age (p < .001) and higher in patients with Crohn's disease or chronic idiopathic pseudo-obstruction. A total of 169 (36.5%) patients were weaned-off HPN mainly (80%) within the first year and most frequently in patients with fistulae. Five of the 14 patients who underwent ITx died. By the end of the study, 104 (23%) of patientsdied on HPN; 65% of deaths occurred within the first 2.5 years of HPN. CONCLUSIONS: Younger ages at HPN initiation and underlying pathologies are significantly predictive of survival on HPN. Risk of death is greatest during the first 2 years of HPN.
Authors: Elisabeth Blüthner; Ulrich-Frank Pape; Martin Stockmann; Mirjam Karber; Sebastian Maasberg; Sophie Pevny; Undine Gerlach-Runge; Andreas Pascher; Johann Pratschke; Frank Tacke; Jan Bednarsch Journal: Nutrients Date: 2020-04-26 Impact factor: 5.717
Authors: Giovanni Di Nardo; Federica Viscogliosi; Francesco Esposito; Vincenzo Stanghellini; Maria Pia Villa; Pasquale Parisi; Alessia Morlando; Girolamo Caló; Roberto De Giorgio Journal: J Neurogastroenterol Motil Date: 2019-10-30 Impact factor: 4.924