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.