Introduction Standard management of type 3 intestinal failure (IF) is long-term parenteral support (PS). While it is clear that PS is lifesaving treatment for IF, it carries significant morbidity and mortality, both dependent and independent of the underlying aetiology of the IF. We report the largest single-centre series assessing the long-term survival of adult patients on all forms of home PS (parenteral nutrition and parenteral fluids) for type 3 IF.
Method Clinical records of 978 adult patients receiving home parenteral support for IF at our tertiary referral centre were analysed from January 1979 until October 2016. Demographic data, underlying aetiology, intestinal length, colonic continuity, complication rates and survival was recorded. Differences between groups were analysed by chi-squared tests. Kaplan-Meier and Cox’s regression models were used to assess factors affecting survival.
Results Overall probability of survival for all patients on PS was 86%, 63%, 52%, 43%, 31%, 24% at 1, 5,10, 15, 20 and 30 years respectively. When active malignancy is excluded as a cause of IF, survival rates were 90%, 66%, 55%, 45%, 33% and 25% (graph 1). There is a significant difference in survival dependent on underlying IF aetiology. The worst 1 year survival of 62% was seen for malignancy and the best with pseudo-obstruction (excluding scleroderma) at 93%. Multivariate analysis demonstrated a significant relationship between survival and the following factors; age at start of PS; HR 1.03 (p<0.001), form of PS; HR 0.48 (p=0.04), presence or absence of colon in continuity; HR 0.42–0.70 (p=0.03), and the aetiologies underlying IF HR 0.74–8.19 (p<0.001).
Conclusion Our data have shown that several factors are associated with long-term survival. A better prognosis was associated with an earlier age of onset of type 3 IF and the presence of colonic continuity, while a worse prognosis was associated with underlying aetiologies such as malignancy and radiation enteritis. To our knowledge, this is the largest single-centre case series looking at survival in type-3 IF to date and adds to our current understanding of the long-term outcomes in type 3 IF.
Disclosure of Interest None Declared
- Intestinal failure
- Parenteral nutrition