Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure

Francisca Joly (Lead / Corresponding author), Janet Baxter, Michael Staun, Darlene G. Kelly, Yi Lisa Hwa, Olivier Corcos, Antonella De Francesco, Federica Agostini, Stanislaw Klek, Lidia Santarpia, Franco Contaldo, Cora Jonker, Geert Wanten, Luisa Chicharro, Rosa Burgos, Andre Van Gossum, Cristina Cuerda, Nuria Virgili, Loris Pironi, on behalf of the ESPEN HAN CIF group

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background & aim: Home parenteral nutrition (HPN) is the primary treatment for chronic intestinal failure (IF). Intestinal transplantation (ITx) is indicated when there is an increased risk of death due to HPN complications or to the underlying disease. Age, pathophysiologic conditions and underlying disease are known predictors of HPN dependency and overall survival. Although the cause of death on HPN is mostly related to underlying disease in these patients, the relationship between mortality and duration of HPN use remains unclear. The purpose of the present study is to describe factors associated with survival and HPN dependency as well as causes of death in adult patients requiring HPN for chronic intestinal failure during the first 5 years of treatment with HPN.

Methods: A multicenter international (European and USA) questionnaire-based retrospective follow-up of a cohort of 472 IF patients who started HPN was conducted between June and December 2000. Study endpoint was either end of 5-year follow-up, weaned-off HPN, ITx, or death on HPN. Data were analyzed for HPN dependence and overall survival using Kaplan-Meier models and log rank tests.

Results: The overall survival probability was 88%, 74% and 64% at 1, 3 and 5 years respectively. Survival was inversely related to age (p < .001) and higher in patients with Crohn's disease or chronic idiopathic pseudo-obstruction. A total of 169 (36.5%) patients were weaned-off HPN mainly (80%) within the first year and most frequently in patients with fistulae. Five of the 14 patients who underwent ITx died. By the end of the study, 104 (23%) of patients died on HPN; 65% of deaths occurred within the first 2.5 years of HPN.

Conclusions: Younger ages at HPN initiation and underlying pathologies are significantly predictive of survival on HPN. Risk of death is greatest during the first 2 years of HPN.

Original languageEnglish
Number of pages8
JournalEuropean Journal of Clinical Nutrition
Early online date19 Jun 2017
DOIs
Publication statusE-pub ahead of print - 19 Jun 2017

Fingerprint

Home Parenteral Nutrition
Cause of Death
Survival

Keywords

  • Intestinal failure
  • Short bowel syndrome
  • Home parenteral nutrition

Cite this

Joly, Francisca ; Baxter, Janet ; Staun, Michael ; Kelly, Darlene G. ; Hwa, Yi Lisa ; Corcos, Olivier ; De Francesco, Antonella ; Agostini, Federica ; Klek, Stanislaw ; Santarpia, Lidia ; Contaldo, Franco ; Jonker, Cora ; Wanten, Geert ; Chicharro, Luisa ; Burgos, Rosa ; Van Gossum, Andre ; Cuerda, Cristina ; Virgili, Nuria ; Pironi, Loris ; on behalf of the ESPEN HAN CIF group. / Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure. In: European Journal of Clinical Nutrition. 2017.
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title = "Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure",
abstract = "Background & aim: Home parenteral nutrition (HPN) is the primary treatment for chronic intestinal failure (IF). Intestinal transplantation (ITx) is indicated when there is an increased risk of death due to HPN complications or to the underlying disease. Age, pathophysiologic conditions and underlying disease are known predictors of HPN dependency and overall survival. Although the cause of death on HPN is mostly related to underlying disease in these patients, the relationship between mortality and duration of HPN use remains unclear. The purpose of the present study is to describe factors associated with survival and HPN dependency as well as causes of death in adult patients requiring HPN for chronic intestinal failure during the first 5 years of treatment with HPN.Methods: A multicenter international (European and USA) questionnaire-based retrospective follow-up of a cohort of 472 IF patients who started HPN was conducted between June and December 2000. Study endpoint was either end of 5-year follow-up, weaned-off HPN, ITx, or death on HPN. Data were analyzed for HPN dependence and overall survival using Kaplan-Meier models and log rank tests.Results: The overall survival probability was 88{\%}, 74{\%} and 64{\%} at 1, 3 and 5 years respectively. Survival was inversely related to age (p < .001) and higher in patients with Crohn's disease or chronic idiopathic pseudo-obstruction. A total of 169 (36.5{\%}) patients were weaned-off HPN mainly (80{\%}) within the first year and most frequently in patients with fistulae. Five of the 14 patients who underwent ITx died. By the end of the study, 104 (23{\%}) of patients died on HPN; 65{\%} of deaths occurred within the first 2.5 years of HPN.Conclusions: Younger ages at HPN initiation and underlying pathologies are significantly predictive of survival on HPN. Risk of death is greatest during the first 2 years of HPN.",
keywords = "Intestinal failure, Short bowel syndrome, Home parenteral nutrition",
author = "Francisca Joly and Janet Baxter and Michael Staun and Kelly, {Darlene G.} and Hwa, {Yi Lisa} and Olivier Corcos and {De Francesco}, Antonella and Federica Agostini and Stanislaw Klek and Lidia Santarpia and Franco Contaldo and Cora Jonker and Geert Wanten and Luisa Chicharro and Rosa Burgos and {Van Gossum}, Andre and Cristina Cuerda and Nuria Virgili and Loris Pironi and {on behalf of the ESPEN HAN CIF group}",
note = "No funding",
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Joly, F, Baxter, J, Staun, M, Kelly, DG, Hwa, YL, Corcos, O, De Francesco, A, Agostini, F, Klek, S, Santarpia, L, Contaldo, F, Jonker, C, Wanten, G, Chicharro, L, Burgos, R, Van Gossum, A, Cuerda, C, Virgili, N, Pironi, L & on behalf of the ESPEN HAN CIF group 2017, 'Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure', European Journal of Clinical Nutrition. https://doi.org/10.1016/j.clnu.2017.06.016

Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure. / Joly, Francisca (Lead / Corresponding author); Baxter, Janet; Staun, Michael; Kelly, Darlene G.; Hwa, Yi Lisa; Corcos, Olivier; De Francesco, Antonella; Agostini, Federica; Klek, Stanislaw; Santarpia, Lidia; Contaldo, Franco; Jonker, Cora; Wanten, Geert; Chicharro, Luisa; Burgos, Rosa; Van Gossum, Andre; Cuerda, Cristina; Virgili, Nuria; Pironi, Loris; on behalf of the ESPEN HAN CIF group.

In: European Journal of Clinical Nutrition, 19.06.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure

AU - Joly, Francisca

AU - Baxter, Janet

AU - Staun, Michael

AU - Kelly, Darlene G.

AU - Hwa, Yi Lisa

AU - Corcos, Olivier

AU - De Francesco, Antonella

AU - Agostini, Federica

AU - Klek, Stanislaw

AU - Santarpia, Lidia

AU - Contaldo, Franco

AU - Jonker, Cora

AU - Wanten, Geert

AU - Chicharro, Luisa

AU - Burgos, Rosa

AU - Van Gossum, Andre

AU - Cuerda, Cristina

AU - Virgili, Nuria

AU - Pironi, Loris

AU - on behalf of the ESPEN HAN CIF group

N1 - No funding

PY - 2017/6/19

Y1 - 2017/6/19

N2 - Background & aim: Home parenteral nutrition (HPN) is the primary treatment for chronic intestinal failure (IF). Intestinal transplantation (ITx) is indicated when there is an increased risk of death due to HPN complications or to the underlying disease. Age, pathophysiologic conditions and underlying disease are known predictors of HPN dependency and overall survival. Although the cause of death on HPN is mostly related to underlying disease in these patients, the relationship between mortality and duration of HPN use remains unclear. The purpose of the present study is to describe factors associated with survival and HPN dependency as well as causes of death in adult patients requiring HPN for chronic intestinal failure during the first 5 years of treatment with HPN.Methods: A multicenter international (European and USA) questionnaire-based retrospective follow-up of a cohort of 472 IF patients who started HPN was conducted between June and December 2000. Study endpoint was either end of 5-year follow-up, weaned-off HPN, ITx, or death on HPN. Data were analyzed for HPN dependence and overall survival using Kaplan-Meier models and log rank tests.Results: The overall survival probability was 88%, 74% and 64% at 1, 3 and 5 years respectively. Survival was inversely related to age (p < .001) and higher in patients with Crohn's disease or chronic idiopathic pseudo-obstruction. A total of 169 (36.5%) patients were weaned-off HPN mainly (80%) within the first year and most frequently in patients with fistulae. Five of the 14 patients who underwent ITx died. By the end of the study, 104 (23%) of patients died on HPN; 65% of deaths occurred within the first 2.5 years of HPN.Conclusions: Younger ages at HPN initiation and underlying pathologies are significantly predictive of survival on HPN. Risk of death is greatest during the first 2 years of HPN.

AB - Background & aim: Home parenteral nutrition (HPN) is the primary treatment for chronic intestinal failure (IF). Intestinal transplantation (ITx) is indicated when there is an increased risk of death due to HPN complications or to the underlying disease. Age, pathophysiologic conditions and underlying disease are known predictors of HPN dependency and overall survival. Although the cause of death on HPN is mostly related to underlying disease in these patients, the relationship between mortality and duration of HPN use remains unclear. The purpose of the present study is to describe factors associated with survival and HPN dependency as well as causes of death in adult patients requiring HPN for chronic intestinal failure during the first 5 years of treatment with HPN.Methods: A multicenter international (European and USA) questionnaire-based retrospective follow-up of a cohort of 472 IF patients who started HPN was conducted between June and December 2000. Study endpoint was either end of 5-year follow-up, weaned-off HPN, ITx, or death on HPN. Data were analyzed for HPN dependence and overall survival using Kaplan-Meier models and log rank tests.Results: The overall survival probability was 88%, 74% and 64% at 1, 3 and 5 years respectively. Survival was inversely related to age (p < .001) and higher in patients with Crohn's disease or chronic idiopathic pseudo-obstruction. A total of 169 (36.5%) patients were weaned-off HPN mainly (80%) within the first year and most frequently in patients with fistulae. Five of the 14 patients who underwent ITx died. By the end of the study, 104 (23%) of patients died on HPN; 65% of deaths occurred within the first 2.5 years of HPN.Conclusions: Younger ages at HPN initiation and underlying pathologies are significantly predictive of survival on HPN. Risk of death is greatest during the first 2 years of HPN.

KW - Intestinal failure

KW - Short bowel syndrome

KW - Home parenteral nutrition

U2 - 10.1016/j.clnu.2017.06.016

DO - 10.1016/j.clnu.2017.06.016

M3 - Article

C2 - 28701261

JO - European Journal of Clinical Nutrition

JF - European Journal of Clinical Nutrition

SN - 0954-3007

ER -