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.

Care of patients on home parenteral nutrition during the first year of the COVID-19 pandemic: Management of central line-associated bloodstream infections.

BACKGROUND AND AIM: The aim of this study was to analyze central line-associated bloodstream infections (CLABSI) in home parenteral nutrition (HPN) patients assisted by an interdisciplinary team during the first year of the COVID-19 pandemic in Argentina. METHODS: Longitudinal, retrospective and analytical study of patients on HPN for ≥90 days during 2020. Data collection included age (adults >18 years, pediatric ≤18 years), gender, diagnosis, type of catheter, number of lumens, venous access, days on HPN, infusion modality and number of CLABSI-associated events. In COVID-19 cases, number of patients, disease progression, mortality rate and microorganisms involved were analyzed. RESULTS: A total of 380 patients were included, 120 (31.6%) pediatric and 260 (68.4%) adult patients. Median age was 44.50 years (10; 62.25). Twelve patients (3.15% of the total) had COVID-19; of these, two pediatric and seven adult patients had no complications, and three adults died of COVID-19 pneumonia. The diagnoses observed were benign chronic intestinal failure (CIF, n = 311), grouped into short bowel (n = 214, 56.3%), intestinal dysmotility (n = 56, 14.7%), intestinal fistula (n = 20, 5.3%), and extensive small bowel mucosal disease (n = 21, 5.5%); malignant tumors (n = 52, 13.7%); other (n = 17, 4.4%). Total catheter days were 103,702. Median days of PN duration per patient were 366 (176.2, 366). The types of catheters used were tunneled (317 patients, 83.4%); peripherally inserted central (PICC) line (55 patients, 14.5%) and ports (8 patients; 2.1%). A total of 111 CLABSI was registered, with a prevalence of 1.09/1000 catheter days (adult, 0.86/1000 days; pediatric, 1.51/1000 days). The microorganisms identified in infectious events were Gram + bacteria (38, 34.5%); Gram-bacteria (36, 32%); mycotic (10, 9%); polymicrobial (4, 3.6%); negative culture and signs/symptoms of CLABSI (23, 20.3%). The odds ratio between pediatric and adult patients was 2.29 (1.35, 3.90). CONCLUSION: The rate of CLABSI during the COVID-19 pandemic was within the ranges reported by international scientific societies. The risk of CLABSI was higher in pediatric patients, and mortality rate in COVID-19 infected patients was higher than in the general population.