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

Am J Clin Nutr. 2014 Oct;100(4):1102-7. doi: 10.3945/ajcn.114.087015. Epub 2014 Aug 13.

Abstract

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.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Body Mass Index
  • Body Weight
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Intensive Care Units
  • Intestinal Diseases / therapy*
  • Male
  • Middle Aged
  • Parenteral Nutrition, Total / methods*
  • Proportional Hazards Models
  • Prospective Studies
  • Retrospective Studies
  • Survival Rate

Associated data

  • ClinicalTrials.gov/NCT02189993