Association between Karnofsky performance status and outcomes in cancer patients on home parenteral nutrition.

BACKGROUND AND AIM: The selection of appropriate criteria is essential to accurately identify cancer patients eligible for home parenteral nutrition (HPN). In this study, the association between Karnofsky Performance Status (KPS) Scale scores and outcomes in cancer patients on HPN was evaluated. METHODS: Retrospective-observational-longitudinal-analytical study of a database of adult cancer patients on HPN. The variables analyzed were sex, age, cancer diagnosis, cancer location (digestive tract and genitourinary), nutritional status, including initial weight (IW), at the start of HPN), usual weight (UW) and IW/UW ratio, and body mass index (BMI) at the start of HPN. Performance status was assessed with the KPS scale. Type of catheter used, number of days on HPN and clinical progression of cancer patients were also studied. RESULTS: Data of 41 cancer patients (60.8% female) were evaluated. Mean age at the start of HPN was 60.45 years. Cancer location was digestive tract (n = 36; 87.8%); gynecologic (n = 4; 9.7%), urinary tract (n = 1; 2.4%). Median IW was 55 kg (45; 64) and BMI was 20 (17.58; 22.84). The IW/UW ratio was -15 kg (-20;-10). The catheters used were peripherally inserted central catheter (n = 30; 73.2%), tunneled (n = 9; 22%) and port (n = 2; 4.8%). The median duration of HPN was 72 days (30; 159). The KPS results showed that 16 cancer patients (39%) had KPS scores ≤50, 17 (41.5%) requiring HPN were discharged and 24 (58.5%) died. The association between disease progression and KPS scores ≤50 was significant (p = 0.025; OR (95% CI): 5.28 (1.07; 36.18). CONCLUSION: The KPS scale is a reliable tool to identify cancer patients eligible for HPN. Cancer patients with ≤50 scores had a five-fold increased risk of death than patients with >50 scores.

Outcomes of the First 54 Pediatric Patients on Long-Term Home Parenteral Nutrition from a Single Brazilian Center.

OBJECTIVES: Data on multidisciplinary programs dedicated to home parenteral nutrition (HPN) in Latin America are limited. This study describes the results of the first multidisciplinary pediatric intestinal rehabilitation program for HPN at a public tertiary hospital in Brazil. METHODS: We retrospectively reviewed patients aged 0-18 years with intestinal failure (IF) who required parenteral nutrition (PN) for >60 days between January/2014 and December/2020. RESULTS: Fifty-four patients were discharged on HPN (15 achieved enteral autonomy, 34 continued on HPN at the end of the study, 1 underwent intestinal transplantation, and 4 died). The median (IQR) age at the study endpoint of patients who achieved enteral autonomy was 14.1 (9.7-19) versus 34.7 (20.4-53.9) months in those who did not achieve enteral autonomy. Overall prevalence of catheter-related thrombosis was 66.7% and catheter-related bloodstream infection rate was 0.39/1000 catheter-days. Intestinal failure-associated liver disease (IFALD) was present in 24% of all patients; none of the patients who achieved enteral autonomy had IFALD. All patients showed significant improvement in anthropometric parameters during the HPN period. The sociodemographic characteristics of the patients' family members were mothers less than 20 years old (7.5%), schooling time more than 10 years (55.5%), and household income between 1 and 3 times the minimum wage (64.8%). The 5-year survival rate for HPN is 90%, and 27.7% of patients achieve enteral autonomy. CONCLUSION: The treatment of pediatric patients with IF followed by a multidisciplinary pediatric intestinal rehabilitation program with HPN is feasible and safe in the Brazilian public health system.

Home parenteral nutrition in pediatric patients with intestinal insufficiency. / Nutrición parenteral domiciliaria en pacientes pediátricos con insuficiencia intestinal.

INTRODUCTION: Home parenteral nutrition (HPN) has been shown to offer important benefits for pa tients and the health system. In Chile, the number of patients who are receiving this type of treatment or who could be candidates for it is unknown. Objetive: To determine the prevalence and clinical characteristics of patients with intestinal insufficiency (II) currently receiving HPN or who are can didates for it. PATIENTS AND METHOD: Cross-sectional descriptive study which included patients aged between 0 to 18 years with diagnosis of II who were receiving parenteral nutrition (PN) for over three months, either at home or in the hospital, with a stable clinical situation and a long-term venous catheter (CVC). Through a digitalized survey, the following variables were collected and studied: gender, birth history, indication to initiate parenteral nutritional support, age of initiation of PN, type of CVC, frequency of PN, nutritional status and feeding in the last control and complications as sociated with the use of PN. Data analysis was performed using the SPSS Statistics Software, Version 21, Macintosh. The descriptive analysis considered frequency analysis and central trend measures. The Chi-square and Fisher tests were used for comparison of proportions. RESULTS: Data from 46 patients were recorded. The average age was 55.5 months. The main indication for initiating the PN was the decrease of the intestinal surface (78.3%). 63% of the patients were hospitalized. No signi ficant differences were found between the place of treatment and the nutritional status and catheter infections variables in the last year. CONCLUSIONS: The prevalence of patients with long-term PN and their clinical characteristics were identified. No differences were found to support the administration of this treatment in the hospital over the home. Public policies must be developed to guarantee the option of receiving this treatment at home.

Nutrición parenteral domiciliaria en pacientes pediátricos con insuficiencia intestinal / Home parenteral nutrition in pediatric patients with intestinal insufficiency

INTRODUCCIÓN: La Nutrición Parenteral Domiciliaria (NPD) ha demostrado ofrecer importantes be neficios para los pacientes y el sistema de salud. En Chile se desconoce el número de pacientes que se encuentran recibiendo esta modalidad de tratamiento o que podrían ser candidatos a ella. OBJETIVO: Determinar la prevalencia y características clínicas de pacientes con Insuficiencia Intestinal (II) que reciben actualmente NPD o que son candidatos a esta. PACIENTES Y MÉTODO: Estudio descriptivo transversal que incluyó pacientes de 0 a 18 años, con diagnóstico de II que se encontraban recibiendo NP por un tiempo superior a 3 meses en el domicilio, o en el hospital con situación clínica estable y con catéter venoso de larga duración (CVC). A través de una encuesta digitalizada se recolectaron y estudiaron las variables: sexo, antecedentes de nacimiento, indicación para iniciar soporte nutricional parenteral, edad de inicio de NP, tipo de CVC utilizado, frecuencia de NP, estado nutricional, alimentación al último control y complicaciones asociadas al uso de NP. Se utilizó el Programa SPSS Statistics, Versión 21, Macintosh, para el análisis de los datos. El análisis descriptivo consideró análisis de frecuencia y medidas de tendencia central. La prueba de Chi cuadrado y de Fisher se usaron para la comparación de proporciones. RESULTADOS: Se registraron datos de 46 pacientes, cuya edad promedio fue de 55,5 meses. La principal indicación para iniciar la Nutrición Parenteral (NP) fue la disminución de la superficie intestinal (78,3%.). El 63% de los pacientes se encontraba hospitalizado. No se encontraron diferencias significativas entre el lugar de tratamiento y las variables estado nutricional e infecciones de catéter en el último año. CONCLUSIONES: Se identificó la prevalencia de pacientes con NP prolongada y sus características clínicas. No se encontraron diferencias que respalden la entrega de este tratamiento en el hospital por sobre el domicilio. Es necesario desarrollar políticas públicas que garanticen la opción de recibir este tratamiento en el domicilio.

INTRODUCTION: Home parenteral nutrition (HPN) has been shown to offer important benefits for pa tients and the health system. In Chile, the number of patients who are receiving this type of treatment or who could be candidates for it is unknown. OBJECTIVE: To determine the prevalence and clinical characteristics of patients with intestinal insufficiency (II) currently receiving HPN or who are can didates for it. PATIENTS Y METHOD: Cross-sectional descriptive study which included patients aged between 0 to 18 years with diagnosis of II who were receiving parenteral nutrition (PN) for over three months, either at home or in the hospital, with a stable clinical situation and a long-term venous catheter (CVC). Through a digitalized survey, the following variables were collected and studied: gender, birth history, indication to initiate parenteral nutritional support, age of initiation of PN, type of CVC, frequency of PN, nutritional status and feeding in the last control and complications as sociated with the use of PN. Data analysis was performed using the SPSS Statistics Software, Version 21, Macintosh. The descriptive analysis considered frequency analysis and central trend measures. The Chi-square and Fisher tests were used for comparison of proportions. RESULTS: Data from 46 patients were recorded. The average age was 55.5 months. The main indication for initiating the PN was the decrease of the intestinal surface (78.3%). 63% of the patients were hospitalized. No significant differences were found between the place of treatment and the nutritional status and catheter infections variables in the last year. CONCLUSIONS: The prevalence of patients with long-term PN and their clinical characteristics were identified. No differences were found to support the administration of this treatment in the hospital over the home. Public policies must be developed to guarantee the option of receiving this treatment at home.

Long-term nutritional assessment of patients with severe short bowel syndrome managed with home enteral nutrition and oral intake.

BACKGROUND: Parenteral nutrition (PN) is used to control the nutritional state after severe intestinal resections. Whenever possible, enteral nutrition (EN) is used to promote intestinal rehabilitation and reduce PN dependency. Our aim is to verify whether EN + oral intake (OI) in severe short bowel syndrome (SBS) surgical adult patients can maintain adequate nutritional status in the long term. METHODS: This longitudinal retrospective study included 10 patients followed for 7 post-operative years. Body mass index (BMI), percentage of involuntary loss of usual body weight (UWL), free fat mass (FFM), and fat mass (FM) composition assessed by bioelectric impedance, and laboratory tests were evaluated at 6, 12, 24, 36, 48, 60, 72, and 84 months after surgery. Energy and protein offered in HPN and at long term by HEN+ oral intake (OI), was evaluated at the same periods. The statistical model of generalized estimating equations with p < 0,05 was used. RESULTS: With long term EN + OI there was a progressive increase in the UWL, a decrease in BMI, FFM, and FM (p < 0,05). PN weaning was possible in eight patients. Infection due to central venous catheter (CVC) contamination was the most common complication (1.2 episodes CVC/patient/year). There was an increase in energy and protein intake supply provided by HEN+OI (p < 0.05). All patients survived for at least 2 years, seven for 5 years and six for 7 years of follow-up. CONCLUSIONS: In the long term SBS surgical adult patients fed with HEN+OI couldn't maintain adequate nutritional status with loss of FM and FFM.

Remaining small bowel length: association with catheter sepsis in patients receiving home total parenteral nutrition: evidence of bacterial translocation.

Patients with short bowel syndrome (SBS) receiving total parenteral nutrition (TPN) have a high incidence of catheter-related sepsis, one of its major complications. The aim of this study was to correlate the length of remaining small bowel (RSB) with septic episodes related to the central venous catheter in a group of patients with severe SBS with home TPN. The length of the RSB (<50 cm or > or = 50 cm) was related to the frequency of catheter sepsis, time until the first episode, and the agents responsible in eight SBS patients receiving home TPN. There were 13 episodes of catheter infection (0.88 per patient-year). The group with a shorter RSB length (five patients) presented 1.3 to 2.76 infections/year and 2 to 9 months until the first episode, compared to 0 to 0.75 infections/ year (p = 0.0357) and 11 to 65 months until the first episode (p = 0.0332) in the group with the longer RSB. In the first group, the agents isolated were Enterobacteriae (Enterobacter sp., Klebsiella sp., Pseudomonas sp., and Proteus sp.) in eight episodes and Candida sp. in one. In the latter sepsis was caused by Staphylococcus sp. in three episodes and Pseudomonas sp. in one. Therefore patients with remaining small bowel shorter than 50 cm have a higher frequency of catheter-related sepsis, particularly by enteric microorganisms. This might be an evidence of the occurrence of bacterial translocation and its role in the pathogenesis of catheter-related sepsis in patients with an extremely short RSB receiving home TPN.

Long-term growth and development in children after home parental nutrition.

Growth and development after the cessation of prolonged parenteral nutrition (PN) has not been fully evaluated. Growth, body composition, and nutritional and developmental status were documented in nine children (five boys, four girls) 2 to 6 years old (mean 4.9 +/- 1.0 years) who had previously received long-term PN (mean 14.6 +/- 11.4 months). PN had been discontinued in all subjects for at least 6 months (mean 3.4 +/- 1.4 years); they were receiving oral feedings only. One subject had a significantly low height-for-age, and another had a low percent ideal body weight; five subjects had low total body fat. Serum vitamin A was low in six subjects. Seventy-two-hour fecal fat analysis was abnormal in two of eight subjects. Abnormal bone mineral density was present in four of nine subjects. Psychomotor development was normal in all nine subjects. Two had functional difficulties in swallowing. One or more abnormalities were present in all nine subjects. These findings suggest that children who require prolonged PN in early life are at risk for abnormalities in growth and nutritional status in later childhood; they require long-term dietary, growth, and nutritional monitoring.