Intravenous Supplementation: A Potential Marker of Chronic Intestinal Failure Severity

IV feeding, intravenous treatment
The type and volume of intravenous supplementation required by patients with chronic intestinal failure could be indicators to categorize the severity of chronic intestinal failure.

The type and volume of intravenous supplementation (IVS) needed for the care of patients with chronic intestinal failure (CIF) indicated the disease severity, according to results from a 1-year internal survey published in Gut.

A total of 2194 patients were enrolled from 51 home parenteral nutrition centers located in 22 counties between 2015 and 2016. All patients were adults (≥ 18 years old) with nonmalignant, ongoing CIF. Patients were receiving either fluid and electrolyte (FE) or parenteral nutrition admixture (PN) IVS in amounts of <1, 1-2, 2-3, or >3 L/d.

The investigators observed that IVS type and volume associated independently with the likelihood that the patient could be weaned from supplementation. Specifically, patients who received ≤1 L/d of PN were more likely to be weaned than were other patients (odds ratio [OR], 0.447; 95% CI, 0.302-0.661; P <.001). Patient death was nonsignificantly lower for those receiving FE (OR, 0.393; 95% CI, 0.139-1.114; P =.079).

Major CIF complications were observed in some of the patient population. Patients receiving either 2-3 or >3 L/d of PN had significantly higher rates of intestinal failure-associated liver disease (odds ratio [OR], 3.794; 95% CI, 1.522-9.458; P =.004; and OR, 4.828; 95% CI, 1.792-13.004; P =.002, respectively) and catheter-related bloodstream infections (OR, 1.664; 95% CI, 1.018-2.721; P =.042; and OR, 2.523; 95% CI, 1.423-4.475; P =.002, respectively).

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The investigators reported 2 major limitations. This study relied on retrospective reporting, which may have resulted in some underreporting. Furthermore, the low sample sizes of patients receiving higher FE doses (>3 L/d n=6 and 2-3 L/d n=10) made statistical conclusions impossible for this cohort.

The authors concluded that the kind and amount of IVS needed by patients with CIF may be an indication of disease severity. These indicators should be incorporated into both clinical practice and research protocols.

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Pironi L, Steiger E, Joly F, et al. Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure [published online January 21, 2020]. Gut. doi:10.1136/gutjnl-2018-318172