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Nutrition
Original research
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. 1Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  2. 2Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Service de Gastroentérologie et d’Assistance nutritive, Hôpital Beaujon, Assistance Publique - Hopitaux de Paris, University of Paris, Clichy, France
  4. 4Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
  5. 5Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
  6. 6Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Piemonte, Italy
  7. 7Stanley Dudrick's Memorial Hospital, Skawina, Poland
  8. 8University Hospital of Wales, Cardiff, Cardiff, UK
  9. 9Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv, Israel
  10. 10Clinical Nutrition Department, M Pirogow Hospital, Lodz, Poland
  11. 11Nottingham University Hospital NHS Trust, Nottingham, UK
  12. 12Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
  13. 13University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
  14. 14Hôpital Haut-Lévêque, Service d'hépato-gastroentérologie, CHU Bordeaux, Pessac, France
  15. 15Center for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
  16. 16School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  17. 17Fundacion Favaloro Hospital Universitario, Buenos Aires, Federal District, Argentina
  18. 18Belfast Health and Social Care Trust, Belfast, Belfast, UK
  19. 19Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
  20. 20Gastroenterology and Artificial Nutrition, Hospital Mons. Dimiccoli, Barletta, Trani, Italy
  21. 21Institute of Oncology, Ljubljana, Slovenia
  22. 22Sahlgrenska Universitetssjukhuset, Goteborg, Sweden
  23. 23Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
  24. 24Uniwersytet Medyczny w Lublinie, Lublin, Lubelskie, Poland
  25. 25Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
  26. 26University Hospital Coventry, Coventry, Coventry, UK
  27. 27J Gromkowski City Hospital, Wroclaw, Poland
  28. 28Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
  29. 29Flinders Medical Centre, Bedford Park, Adelaide, Australia
  30. 30Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
  31. 31Centre 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. 32Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
  33. 33Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  34. 34Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
  35. 35St Imre Hospital, Budapest, Hungary
  36. 36Unitat de Nutrició i Dietètica, Hospital Universitari Bellvitge, L'Hospitalet Llobregat, Barcelona, Spain
  37. 37Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  38. 38Clinical Nutrition, IRCCS-INRCA, Ancona, Marche, Italy
  39. 39Centre for Intestinal Failure, Uniwersytet Medyczny imienia Karola Marcinkowskiego w Poznaniu, Poznan, Poland
  40. 40Gastroenterology, UCLH, London, UK
  41. 41Bulgarian Executive Agency of Transplantation, Sofia, Bulgaria
  42. 42Unita' Locale Socio-Sanitaria N° 22, Bussolengo, Verona, Italy
  43. 43Azienda Unita Sanitaria Locale di Parma, Parma, Emilia-Romagna, Italy
  44. 44Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
  45. 45Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, DF, Mexico
  46. 46Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
  47. 47University Hospital Centre Zagreb, Zagreb, Croatia
  48. 48Complejo Hospitalario de Navarra, Pamplona, Spain
  49. 49Hospital Virgen del Camino, Pamplona, Navarra, Spain
  50. 50Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Canarias, Spain
  51. 51Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
  52. 52Gastroenterology 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}unibo.it

Abstract

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

https://doi.org/10.1136/gutjnl-2018-318172

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    Footnotes

    • 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.