Abstract:
Background: Survival of patients with short bowel syndrome (SBS) receiving home parenteral nutrition (HPN) and associated factors haven’t been reported recently in North America. The objective of this study was to determine the long-term survival of adult patients with SBS as the primary indication for HPN and assess factors that may affect survival using the Canadian HPN registry.
Methods: This is a retrospective analysis of prospectively collected data extracted from the HPN Registry, prior to approval of teduglutide in Canada. Using only incident cases, survival probabilities were estimated using the Kaplan-Meier method for both full cohort and non-malignant SBS. Log-rank test was also employed to test the differences in survival distributions between subgroups in the univariate analysis. To identify potential variables that are affecting survival distribution of patients for the multivariable analysis, Least Absolute Shrinkage and Selection Operator (LASSO) and stepwise selection procedure were used.
Results: There were 321 patients with a known duration on HPN (total 2287 years), of whom 218 were entered into the Registry within one year of initiation of HPN. Of 218 incident cases, 22 had active malignancy along with SBS and their survival time was significantly lower than those with non-malignant SBS (p-value < 0.0001). The 5-year survival of non-malignant SBS patients was 81.9%. In this subgroup, there was no significant association between patients' survival and known intestinal anatomy, age or sex.
Conclusion: Patients with non-malignant SBS on HPN have a 5-year survival of more than 80%. Known intestinal anatomical factors did not affect survival.
Reference:
Noelting J, Gramlich L, Whittaker S, et al. Survival of Patients With Short Bowel Syndrome on Home Parenteral Nutrition: A Prospective Cohort Study [published online ahead of print, 2020 Aug 2]. JPEN J Parenter Enteral Nutr. 2020;10.1002/jpen.1984. doi:10.1002/jpen.1984