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Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure
  1. Loris Pironi1,
  2. Ezra Steiger2,
  3. Francisca Joly3,
  4. Geert J A Wanten4,
  5. Cecile Chambrier5,
  6. Umberto Aimasso6,
  7. Anna Simona Sasdelli1,
  8. Kinga Szczepanek7,
  9. Amelia Jukes8,
  10. Miriam Theilla9,
  11. Marek Kunecki10,
  12. Joanne Daniels11,
  13. Mireille J Serlie12,
  14. Sheldon C Cooper13,
  15. Florian Poullenot14,
  16. Henrik Højgaard Rasmussen15,
  17. Charlene W Compher16,
  18. Adriana Crivelli17,
  19. Sarah-Jane Hughes18,
  20. Lidia Santarpia19,
  21. Francesco William Guglielmi20,
  22. Nada Rotovnik Kozjek21,
  23. Lars Ellegard22,
  24. Stéphane M Schneider23,
  25. Przemysław Matras24,
  26. Alastair Forbes25,
  27. Nicola Wyer26,
  28. Anna Zmarzly27,
  29. Marina Taus28,
  30. Margie O'Callaghan29,
  31. Emma Osland30,
  32. Ronan Thibault31,
  33. Cristina Cuerda32,
  34. Lynn Jones33,
  35. Brooke Chapman34,
  36. Peter Sahin35,
  37. Núria M Virgili36,
  38. Andre Dong Won Lee37,
  39. Paolo Orlandoni38,
  40. Konrad Matysiak39,
  41. Simona Di Caro40,
  42. Maryana Doitchinova-Simeonova41,
  43. Luisa Masconale42,
  44. Corrado Spaggiari43,
  45. Carmen Garde44,
  46. Aurora E Serralde-Zúñiga45,
  47. Gabriel Olveira46,
  48. Zeljko Krznaric47,
  49. Estrella Petrina Jáuregui48,
  50. Ana Zugasti Murillo49,
  51. José P Suárez-Llanos50,
  52. Elena Nardi1,
  53. André Van Gossum51,
  54. Simon Lal52
  1. 1 Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  2. 2 Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3 Service de Gastroentérologie et d’Assistance nutritive, Hôpital Beaujon, Assistance Publique - Hopitaux de Paris, University of Paris, Clichy, France
  4. 4 Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
  5. 5 Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
  6. 6 Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Piemonte, Italy
  7. 7 Stanley Dudrick's Memorial Hospital, Skawina, Poland
  8. 8 University Hospital of Wales, Cardiff, Cardiff, UK
  9. 9 Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv, Israel
  10. 10 Clinical Nutrition Department, M Pirogow Hospital, Lodz, Poland
  11. 11 Nottingham University Hospital NHS Trust, Nottingham, UK
  12. 12 Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
  13. 13 University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
  14. 14 Hôpital Haut-Lévêque, Service d'hépato-gastroentérologie, CHU Bordeaux, Pessac, France
  15. 15 Center for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
  16. 16 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  17. 17 Fundacion Favaloro Hospital Universitario, Buenos Aires, Federal District, Argentina
  18. 18 Belfast Health and Social Care Trust, Belfast, Belfast, UK
  19. 19 Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
  20. 20 Gastroenterology and Artificial Nutrition, Hospital Mons. Dimiccoli, Barletta, Trani, Italy
  21. 21 Institute of Oncology, Ljubljana, Slovenia
  22. 22 Sahlgrenska Universitetssjukhuset, Goteborg, Sweden
  23. 23 Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
  24. 24 Uniwersytet Medyczny w Lublinie, Lublin, Lubelskie, Poland
  25. 25 Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
  26. 26 University Hospital Coventry, Coventry, Coventry, UK
  27. 27 J Gromkowski City Hospital, Wroclaw, Poland
  28. 28 Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
  29. 29 Flinders Medical Centre, Bedford Park, Adelaide, Australia
  30. 30 Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
  31. 31 Centre de référence Maladies Rares Digestives, Unité de Nutrition, CHU Rennes, INRAE, INSERM, Universite de Rennes, Nutrition Metabolisms and Cancer institute, NuMeCan, Rennes, Bretagne, France
  32. 32 Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
  33. 33 Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  34. 34 Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
  35. 35 St Imre Hospital, Budapest, Hungary
  36. 36 Unitat de Nutrició i Dietètica, Hospital Universitari Bellvitge, L'Hospitalet Llobregat, Barcelona, Spain
  37. 37 Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  38. 38 Clinical Nutrition, IRCCS-INRCA, Ancona, Marche, Italy
  39. 39 Centre for Intestinal Failure, Uniwersytet Medyczny imienia Karola Marcinkowskiego w Poznaniu, Poznan, Poland
  40. 40 Gastroenterology, UCLH, London, UK
  41. 41 Bulgarian Executive Agency of Transplantation, Sofia, Bulgaria
  42. 42 Unita' Locale Socio-Sanitaria N° 22, Bussolengo, Verona, Italy
  43. 43 Azienda Unita Sanitaria Locale di Parma, Parma, Emilia-Romagna, Italy
  44. 44 Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
  45. 45 Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  46. 46 Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
  47. 47 University Hospital Centre Zagreb, Zagreb, Croatia
  48. 48 Complejo Hospitalario de Navarra, Pamplona, Spain
  49. 49 Hospital Virgen del Camino, Pamplona, Navarra, Spain
  50. 50 Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Canarias, Spain
  51. 51 Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
  52. 52 Gastroenterology and Intestinal Failure Unit, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
  1. Correspondence to Professor Loris Pironi, Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; loris.pironi{at}


Background and aim No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity.

Methods At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1–2, 2–3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI).

Results Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN >3 L/day).

Conclusions The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.

  • intestinal failure
  • parenteral nutrition
  • liver failure
  • short bowel syndrome
  • motility disorders

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  • Correction notice This article has been corrected since it published Online First. Tables 1 and 2 have been amended.

  • Collaborators The Home Artificial Nutrition and Chronic Intestinal Failure special interest group of the European Society for Clinical Nutrition and Metabolism (ESPEN).

  • Contributors LP devised the study protocol, collected the data, analysed the results and drafted the manuscript. The Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN discussed and approved the protocol study, discussed the results and reviewed the manuscript before submission. All coauthors participated in the acquisition of data, revised the final analysis, approved the final version of the manuscript and were accountable for all aspects of the work.

  • Funding The project of the ESPEN database for chronic intestinal failure was supported by an ESPEN grant.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Home Artificial Nutrition and Chronic Intestinal Failure (HAN&CIF) special interest group of ESPEN. The research was based on anonymised information taken from patient records at the time of data collection. The study was conducted with full regard to confidentiality of the individual patient. Each patient was labelled with two anonymised identifications: one given by the HPN centre and one given by the database manager. Ethical committee approval was obtained by the individual HPN centres according to local regulations. The collected data were used only for the study purpose. Contributing centres have been anonymised for data analysis and presentation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Author note The project of the ESPEN database for chronic intestinal failure was promoted by the ESPEN Executive Committee in 2013 and was approved by the ESPEN Council.