Limited long-term survival after in-hospital intestinal failure requiring total parenteral nutrition

作者：Oterdoom Leendert Harmen^*; ten Dam Suzanne Marije; de Groot Sabine Dorine Willemine; Arjaans Willy; van Bodegraven Adriaan Anthonie

来源：American Journal of Clinical Nutrition, 2014, 100(4): 1102-1107.

DOI：10.3945/ajcn.114.087015

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.

• 出版日期2014-10