Abstract:
Background: There is a demographic shift toward older patients receiving home parenteral nutrition (HPN) but data on clinical outcomes is limited. The objective of this study was to determine differences between older and younger HPN patients in regard to HPN indications, prescriptions and outcomes over the first 2 years receiving HPN.
Methods: This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for at least 2 years were selected. Data included demographics, PN prescriptions, catheter-related bloodstream infections (CRBSI) over the past year, survival and quality of life based (Karnofsky Performance Status (KPS)).
Results: 402 patients were included: 184 patients were ≥ 60 years old and 219 patients were between 18 and 59 years old. There were no significant differences in the main indications for HPN, body mass index (BMI) and PN prescriptions at baseline. At 2-years, younger patients received more calories from PN than older patients (27.9 vs 19.6 kcal/kg respectively, p <0.001) but BMI remained comparable. There were fewer CRBSI in the older group versus the younger group (20% vs 36%, p = 0.0023) but 78% of younger patients remained alive versus 69% in the older group (p = 0.0401). In those alive, the proportion of patients remaining on HPN was comparable as well as the proportion of patients with a KPS ≥ 60.
Conclusions: Older HPN patients have similar clinical characteristics as younger patients but have reduced CRBSI and higher 2-year mortality.
Reference:
Daoud DC, Cartagena EMS, Schwenger KJP, Somlaw N, Gramlich L, Whittaker S, Armstrong D, Jurewitsch B, Raman M, Duerksen DR, McHattie JD, Allard JP. Home parenteral nutrition in older versus younger patients: Clinical characteristics and outcomes. JPEN J Parenter Enteral Nutr. 2021 Apr 3. doi: 10.1002/jpen.2117. Epub ahead of print. PMID: 33811677.