51. Limited long-term survival after in-hospital intestinal failure requiring total parenteral nutrition
- Author
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Adriaan A. van Bodegraven, Willy Arjaans, Sabine D. W. de Groot, Leendert H. Oterdoom, Suzanne Marije ten Dam, Gastroenterology and hepatology, and CCA - Innovative therapy
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Medicine (miscellaneous) ,law.invention ,Body Mass Index ,law ,medicine ,Humans ,Mass index ,Prospective Studies ,Prospective cohort study ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Nutrition and Dietetics ,business.industry ,Proportional hazards model ,Surrogate endpoint ,Mortality rate ,Body Weight ,Middle Aged ,Intensive care unit ,Hospitalization ,Survival Rate ,Intensive Care Units ,Intestinal Diseases ,Parenteral nutrition ,Cohort ,Female ,Parenteral Nutrition, Total ,business ,Follow-Up Studies - Abstract
Background: Total parenteral nutrition (TPN) is an invasive and advanced rescue feeding technique that has acceptable short-term survival although at costs of substantial risks. Survival after the clinical use of TPN .6 mo is unknown. Objective: We determined long-term survival after clinical TPN use in a consecutive cohort who were attending an academic hospital. Design: The study included a prospective cohort with a retrospective analysis of all 537 consecutive episodes of TPN in 437 patients between January 2010 and April 2012. Follow-up was until October 2013 with a total follow-up of 608 patient-years. Survival was analyzed by using Kaplan-Meier and Cox regression. Results: Survival was 58% in 437 patients with a first-time use of TPN at an average of 1.5 y after the initiation of TPN. The mortality rate was 30 deaths/100 patient-years. Older age, admission at an intensive care unit or a nonsurgical department, lower body mass index, and an underlying malignancy were positively associated with mortality. Conclusion: TPN use, if correctly indicated, is a clinical sign of intestinal failure and a surrogate marker for markedly increased risk of mortality even .1.5 y after TPN use. This trial was registered at clinicaltrials.gov as NCT02189993 with protocol identification name TPN-01. Am J Clin Nutr doi: 10.3945/ajcn.114.087015.
- Published
- 2014