Sorrel Burden1, Matthew Hemstock2, Michael Taylor3, Antje Teubner3, Neil Roskell2, Alasdair MacCulloch4, Arun Abraham3, Simon Lal5. 1. School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK; Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK. Electronic address: Sorrel.burden@manchester.ac.uk. 2. BresMed Health Solutions LTD, North Church House, 84 Queen Street, Sheffield, S1 2DW, UK. 3. Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK. 4. Amicus Therapeutics UK LTD, Oxford Road, Bucks, Sl9 7AP, UK. 5. Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK; School of Medicine, The University of Manchester, Manchester, M13 9PL, UK.
Abstract
INTRODUCTION: Home parenteral nutrition (HPN) provides fluid and nutrition essential for the survival of patients with type 3 intestinal failure (IF). However, it is associated with complications and re-admission to hospital. This study aims to investigate the effect of HPN on mortality, morbidity and hospital re-admissions. METHOD: This is a retrospective cohort study. All patients newly dependent on HPN discharged over a 4-year period between 2011 and 2015 were included. Patients' characteristics, nutritional status and diagnosis were recorded, along with frequency and duration of HPN administration. Outcomes collected included hospital re-admissions, morbidity, catheter related blood stream infections (CRBSIs) and mortality. Regression analyses were performed to estimate the rate of different outcomes adjusted for prognostic factors. RESULTS: There were 210 patients included, 561 separate HPN prescriptions equating to 110,537 catheter days. Total number of deaths was 44 (0.398 deaths per 1000 catheter days). There were 196 re-admissions to hospital recorded for a total of 5594 days, 69 (33%) of these re-admissions were unplanned (2484 days in hospital). Principle reasons for unplanned re-admissions included: CRBSIs (n = 31, 45%); other sepsis (n = 10, 14.5%) and abdominal symptoms (n = 9, 13%). CRBSIs were recorded in 22 (10%) patients, equating to a rate of 0.199 per 1000 catheter days. Days per week on HPN increased the relative rate (RR) of time in hospital due to any reason or for unplanned readmissions, RR 1.50 (95% CI: 1.26, 1,78 p < 0.001) and RR 1.39 (95% CI: 1.10, 1.75 p = 0.006) respectively. However, there was no association between days per week on HPN and CRBSI occurrence. CONCLUSION: Unplanned re-admissions for patients with IF accounted for a third of all hospitalisations in those on HPN and the majority were due to CRBSI. The number of HPN dependent days per week was related to all-cause unplanned re-admissions, although not to CRBSI rate.
INTRODUCTION: Home parenteral nutrition (HPN) provides fluid and nutrition essential for the survival of patients with type 3 intestinal failure (IF). However, it is associated with complications and re-admission to hospital. This study aims to investigate the effect of HPN on mortality, morbidity and hospital re-admissions. METHOD: This is a retrospective cohort study. All patients newly dependent on HPN discharged over a 4-year period between 2011 and 2015 were included. Patients' characteristics, nutritional status and diagnosis were recorded, along with frequency and duration of HPN administration. Outcomes collected included hospital re-admissions, morbidity, catheter related blood stream infections (CRBSIs) and mortality. Regression analyses were performed to estimate the rate of different outcomes adjusted for prognostic factors. RESULTS: There were 210 patients included, 561 separate HPN prescriptions equating to 110,537 catheter days. Total number of deaths was 44 (0.398 deaths per 1000 catheter days). There were 196 re-admissions to hospital recorded for a total of 5594 days, 69 (33%) of these re-admissions were unplanned (2484 days in hospital). Principle reasons for unplanned re-admissions included: CRBSIs (n = 31, 45%); other sepsis (n = 10, 14.5%) and abdominal symptoms (n = 9, 13%). CRBSIs were recorded in 22 (10%) patients, equating to a rate of 0.199 per 1000 catheter days. Days per week on HPN increased the relative rate (RR) of time in hospital due to any reason or for unplanned readmissions, RR 1.50 (95% CI: 1.26, 1,78 p < 0.001) and RR 1.39 (95% CI: 1.10, 1.75 p = 0.006) respectively. However, there was no association between days per week on HPN and CRBSI occurrence. CONCLUSION: Unplanned re-admissions for patients with IF accounted for a third of all hospitalisations in those on HPN and the majority were due to CRBSI. The number of HPN dependent days per week was related to all-cause unplanned re-admissions, although not to CRBSI rate.
Authors: Maja Kopczynska; Gordon Carlson; Antje Teubner; Arun Abraham; Michael Taylor; Sorrel T Burden; Christian L Hvas; Peter Jepsen; Simon Lal Journal: Nutrients Date: 2022-03-30 Impact factor: 5.717
Authors: Kiran V K Koelfat; Denis Picot; Xinwei Chang; Ronan Thibault; Frank G Schaap; Steven W M Olde Damink; Mireille Desille-Dugast; Hans M van Eijk; Sander M J van Kuijk; Martin Lenicek; Sabrina Layec; Marie Carsin; Laurence Dussaulx; Eloi Seynhaeve; Florence Trivin; Laurence Lacaze Journal: Hepatology Date: 2021-08-26 Impact factor: 17.425