Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre.

Abstract

BACKGROUND:

Comparisons between safety and efficacy of home parenteral nutrition and of intestinal transplantation for treatment of chronic intestinal failure derived from observational studies.

AIMS:

To present the 16-year experience of home parenteral nutrition by the Chronic Intestinal Failure Centre of Bologna University.

PATIENTS:

A total of 40 adult patients were enrolled between 1986 and 2001.

METHODS:

Safety indices: survival and cause of death, catheter-related bloodstream infection, deep vein thrombosis, liver disease. Efficacy indices: nutritional and rehabilitation status, quality of life (SF36 instrument), re-hospitalisation rate.

STATISTICS:

Kaplan-Maier analysis and Cox model for survival probability and risk factors; logistic regression for catheter-related bloodstream infection risk factors.

RESULTS:

Survival rates at 1, 3 and 5 years were 97, 82 and 67% respectively. Survival was higher in patients < or = 40 years. One death was home parenteral nutrition-related. Incidence of catheter-related bloodstream infection: 0.30/year home parenteral nutrition, was lower in patients treated by a specialized nursing protocol. Incidence of deep vein thrombosis was 0.05/year home parenteral nutrition. Hepatosteatosis occurred in 55%. Body weight remained stable or increased in 80%. Rehabilitation was total or partial in 74%. Re-hospitalisation rate was 0.70/year home parenteral nutrition. Quality of life scored significantly lower than in healthy populations in six out of eight domains.

CONCLUSIONS:

Home parenteral nutrition is a safe and efficacious therapy for chronic intestinal failure. Survival compares favourably with survival after intestinal transplantation.

• Authors: L Pironi, F Paganelli, A M M Labate, C Merli, C Guidetti, G Spinucci, M Miglioli
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 35 Issue 5 Pg. 314-24 (May 2003) ISSN: 1590-8658 [Print] Netherlands
• PMID: 12846403 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Cause of Death
• Chronic Disease
• Female
• Humans
• Intestinal Diseases (mortality, therapy)
• Male
• Middle Aged
• Nutritional Status
• Parenteral Nutrition, Home
• Quality of Life
• Retrospective Studies
• Treatment Outcome