Christina Belza1, Kevin Fitzgerald1, Nicole de Silva1, Yaron Avitzur1,2, Paul W Wales1,3. 1. Group for Improvement of Intestinal Function and Treatment, University of Toronto, Toronto, Canada. 2. Division of Gastroenterology, Hepatology and Nutrition, University of Toronto, Toronto, Canada. 3. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Abstract
INTRODUCTION: Patients with short bowel syndrome (SBS) are dependent on parenteral nutrition (PN) while their bowel attempts to compensate. Our objective was to create an SBS disease severity score to predict the probability of achieving enteral autonomy (EA). METHODS: A retrospective cohort study of children with SBS managed by our Intestinal Rehabilitation Program was completed. Data abstracted included demographic, bowel anatomy, and outcome variables including conjugated bilirubin (CB) and enteral nutrition (EN) tolerated 6 months postoperatively. Univariate analysis and Cox proportional hazards (CPH) model were performed. A score was created based on weighting of coefficients. An α-value of < 0.05 was considered significant. RESULTS: One hundred thirty-nine patients were analyzed (61% males). Ninety-five (68%) achieved EA. Patients possessing >50% residual small bowel (hazard ratio [HR] 2.68 [95% confidence interval {CI} 1.60-4.49], P < 0.001), ileocecal valve intact (HR 0.61 [95% CI 0.37-1.01], P < 0.055), and >50% enteral tolerance at 6 months (HR 5.70 [95% CI 2.77-11.74] P < 0.001) were positively associated with EA. CB >34 µmol/L (2 mg/dL) was negatively associated with EA (HR 0.42 [95% CI0.27-0.66], P < 0.001). A severity score was created by weighting CPH parameter estimates (small bowel length >50%, ileocecal valve intact, CB <34 µmol/L, and EN >50% for a maximum score of 8), and disease severity strata were developed (severe [25.7% EA], moderate [52.9% EA], and mild [97.1% EA]). CONCLUSION: We propose a pediatric SBS disease severity score that predicts probability of EA. The score allows prognostication of individual patients and could assist research by adjusting outcome reporting or stratifying recruitment.
INTRODUCTION:Patients with short bowel syndrome (SBS) are dependent on parenteral nutrition (PN) while their bowel attempts to compensate. Our objective was to create an SBS disease severity score to predict the probability of achieving enteral autonomy (EA). METHODS: A retrospective cohort study of children with SBS managed by our Intestinal Rehabilitation Program was completed. Data abstracted included demographic, bowel anatomy, and outcome variables including conjugated bilirubin (CB) and enteral nutrition (EN) tolerated 6 months postoperatively. Univariate analysis and Cox proportional hazards (CPH) model were performed. A score was created based on weighting of coefficients. An α-value of < 0.05 was considered significant. RESULTS: One hundred thirty-nine patients were analyzed (61% males). Ninety-five (68%) achieved EA. Patients possessing >50% residual small bowel (hazard ratio [HR] 2.68 [95% confidence interval {CI} 1.60-4.49], P < 0.001), ileocecal valve intact (HR 0.61 [95% CI 0.37-1.01], P < 0.055), and >50% enteral tolerance at 6 months (HR 5.70 [95% CI 2.77-11.74] P < 0.001) were positively associated with EA. CB >34 µmol/L (2 mg/dL) was negatively associated with EA (HR 0.42 [95% CI0.27-0.66], P < 0.001). A severity score was created by weighting CPH parameter estimates (small bowel length >50%, ileocecal valve intact, CB <34 µmol/L, and EN >50% for a maximum score of 8), and disease severity strata were developed (severe [25.7% EA], moderate [52.9% EA], and mild [97.1% EA]). CONCLUSION: We propose a pediatric SBS disease severity score that predicts probability of EA. The score allows prognostication of individual patients and could assist research by adjusting outcome reporting or stratifying recruitment.
Authors: Lotte E Vlug; Esther G Neelis; Jonathan C K Wells; Mary S Fewtrell; Wendy L M Kastelijn; Joanne F Olieman; Marijn J Vermeulen; Jorine A Roelants; Dimitris Rizopoulos; René M H Wijnen; Edmond H H M Rings; Barbara A E de Koning; Jessie M Hulst Journal: Am J Clin Nutr Date: 2022-02-09 Impact factor: 7.045
Authors: Antonella Lezo; Antonella Diamanti; Evelyne M Marinier; Merit Tabbers; Anat Guz-Mark; Paolo Gandullia; Maria I Spagnuolo; Sue Protheroe; Noel Peretti; Laura Merras-Salmio; Jessie M Hulst; Sanja Kolaček; Looi C Ee; Joanna Lawrence; Jonathan Hind; Lorenzo D'Antiga; Giovanna Verlato; Ieva Pukite; Grazia Di Leo; Tim Vanuytsel; Maryana K Doitchinova-Simeonova; Lars Ellegard; Luisa Masconale; María Maíz-Jiménez; Sheldon C Cooper; Giorgia Brillanti; Elena Nardi; Anna S Sasdelli; Simon Lal; Loris Pironi Journal: Nutrients Date: 2022-04-30 Impact factor: 6.706