Palliative home parenteral nutrition: Clinical service evaluation and identifying potential prognostic factors to assist with patient selection.

Drinkwater, B and Clarke, B K and Jones, J and Ratcliffe, J and Deel-Smith, P and Cooper, S C (2017) Palliative home parenteral nutrition: Clinical service evaluation and identifying potential prognostic factors to assist with patient selection. Clinical nutrition ESPEN, 22. pp. 81-84. ISSN 2405-4577. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://clinicalnutritionespen.com/article/S2405-4...

Abstract

BACKGROUND AND AIMS

Home parenteral nutrition (HPN) for palliation has little evidence supporting existing guidance. Patient selection remains challenging. We aimed to evaluate use of palliative HPN in our service against ESPEN guidance, and to identify potential prognostic indicators.

METHODS

Palliative care patients commenced on HPN were identified. Medical notes, computer records and HPN database were accessed to identify patient demographics, primary diagnosis and aetiology of intestinal failure, blood test results potentially associated with prognosis (eGFR, albumin, CRP, Hb), presence of ascites, and PN duration. By dichotomising blood results Kaplan-Meier survival plots were derived to identify potential associations with survival.

RESULTS

From the HPN database of 111 patients, 20 (18%) were identified as palliative. Six were male (30%), median age (interquartile range (IQR)) 56.4 (51.5-66.8) years. Four patients commenced palliative HPN between 2000 and 2006, while 2007-2013 there were 16. The median number (IQR) of nights on HPN was 85 (19-352). The most common indication was gastro-intestinal obstruction (n = 13, 65%) and short bowel syndrome following palliative surgical resection (n = 4, 20%). Kaplan-Meier survival plots identified worse prognosis on HPN if the presenting albumin was ≤30 g/L p = 0.016.

CONCLUSION

The use of HPN in palliative care is increasing. Current patient selection meets with ESPEN guidance with respect to aetiology of intestinal failure and length of survival on PN. We suggest that a low albumin (not a marker of malnutrition) may help to predict those who are likely to survive less long on palliative HPN. A multi-centre prospective study, also examining quality of life would help define improved guidance.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WA Patients. Primary care. Medical profession. Forensic medicine
WD Diseases and disorders of systemic, metabolic or environmental origin > WD10 Diet and nutrition
WI Digestive system. Gastroenterology
WX Health services
Divisions: Planned IP Care > Gastroentrology
Related URLs:
Depositing User: Beth Connors
Date Deposited: 10 May 2019 13:57
Last Modified: 10 May 2019 13:57
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/2087

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