COVID-19 infection in patients on long-term home parenteral nutrition for chronic intestinal failure

To investigate the incidence and the severity of COVID-19 infection in patients enrolled in the database for home parenteral nutrition (HPN) for chronic intestinal failure (CIF) of the European Society for Clinical Nutrition and Metabolism (ESPEN).Period of observation: March 1st, 2020 March 1st, 2021.patients included in the database since 2015 and still receiving HPN on March 1st, 2020 as well as new patients included in the database during the period of observation. Data related to the previous 12 months and recorded on March 1st 2021: 1) occurrence of COVID-19 infection since the beginning of the pandemic (yes, no, unknown); 2) infection severity (asymptomatic; mild, no-hospitalization; moderate, hospitalization no-ICU; severe, hospitalization in ICU); 3) vaccinated against COVID-19 (yes, no, unknown); 4) patient outcome on March 1st 2021: still on HPN, weaned off HPN, deceased, lost to follow up.Sixty-eight centres from 23 countries included 4680 patients. Data on COVID-19 were available for 55.1% of patients. The cumulative incidence of infection was 9.6% in the total group and ranged from 0% to 21.9% in the cohorts of individual countries. Infection severity was reported as: asymptomatic 26.7%, mild 32.0%, moderate 36.0%, severe 5.3%. Vaccination status was unknown in 62.0% of patients, non-vaccinated 25.2%, vaccinated 12.8%. Patient outcome was reported as: still on HPN 78.6%, weaned off HPN 10.6%, deceased 9.7%, lost to follow up 1.1%. A higher incidence of infection (p = 0.04), greater severity of infection (p < 0.001) and a lower vaccination percentage (p = 0.01) were observed in deceased patients. In COVID-19 infected patients, deaths due to infection accounted for 42.8% of total deaths.In patients on HPN for CIF, the incidence of COVID-19 infection differed greatly among countries. Although the majority of cases were reported to be asymptomatic or have mild symptoms only, COVID-19 was reported to be fatal in a significant proportion of infected patients. Lack of vaccination was associated with a higher risk of death

Impact of route and adequacy of nutritional intake on outcomes of allogeneic haematopoietic cell transplantation for haematologic malignancies.

BACKGROUND: Allogeneic haematopoietic cell transplantation (HCT) is often associated with poor oral intake due to painful mucositis and gastrointestinal sequalae that occur following a preparative regimen of intensive chemotherapy and/or total body radiation. Although attractive to assume that optimal nutrition improves HCT outcomes, there are limited data to support this. It is also unclear whether artificial nutrition support should be provided as enteral tube feeding or parenteral nutrition (PN). METHODS: We analysed day-100 non-relapse mortality (NRM), incidence of acute graft-versus-host disease (GvHD), acute gastrointestinal GvHD, 5-year survival and GvHD-free/relapse-free survival (GRFS) according to both route and adequacy of nutritional intake prior to neutrophil engraftment, together with other known prognostic factors, in a retrospective cohort of 484 patients who underwent allogeneic HCT for haematologic malignancy between 2000 and 2014. RESULTS: Multivariate analyses showed increased NRM with inadequate nutrition (hazard ratio (HR) 4.1; 95% confidence interval (CI) 2.2-7.2) and adequate PN (HR 2.9; 95% CI 1.6-5.4) compared to adequate enteral nutrition (EN) both P < .001. There were increased incidences of gastrointestinal GvHD of any stage and all GvHD ≥ grade 2 in patients who received PN (odds ratio (OR) 2.0; 95% CI 1.2-3.3; P = .006, and OR 1.8; 95% CI 1.1-3.0; P = .018, respectively), compared to adequate EN. Patients who received adequate PN and inadequate nutrition also had reduced probabilities of survival and GRFS at 5 years. CONCLUSION: Adequate EN during the early transplantation course is associated with reduced NRM, improved survival and GRFS at 5 years. Furthermore, adequate EN is associated with lower incidence of overall and gut acute GvHD than PN, perhaps because of its ability to maintain mucosal integrity, modulate the immune response to intensive chemo/radiotherapy and support the gastrointestinal tract environment, including gut microflora

Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients:An international survey

Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care

Evaluation non-invasive de la fibrose hépatique chez les patients dépendants d une nutrition parentérale à domicile

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Validation d'un outil diagnostique de la dénutrition à l'hôpital (étude sur deux échantillons de patients hospitalisés au CHRU de Lille entre janvier 2009 et juin 2011)

Contexte: La dénutrition à l hôpital est un problème majeur de santé publique qui reste largement sous estimé faute d outil diagnostique infaillible pour la reconnaître. Ce défaut de diagnostic est d autant plus préjudiciable aux patients que la dénutrition est reconnue pour augmenter la morbidité, la mortalité et altérer la qualité de vie. Le but de l étude était de tester l efficacité d un nouvel outil de dépistage de la dénutrition. Méthode: L outil combine 4 critères cliniques simples: l âge, le poids, la circonférence brachiale et la recherche d une escarre. Il permet le calcul d un score de 0 à 5 points, avec un seuil de positivité >= 3. Nous l avons testé sur 2 échantillons de patients hospitalisés au CHRU de Lille entre Janvier 2009 et Juin 2011, différant par leur recrutement: patients pris en charge par l unité transversale de nutrition ou recrutés de manière aléatoire. Résultats: Les effectifs étaient de 2692 et 149 patients, la prévalence de la dénutrition était de 75% (moyenne d âge 59 ans +/- 15) et de 55% (moyenne d âge 59 ans +/- 17), la sensibilité de l outil était de 25% et 27%, la spécificité de 96% et 90%, la VPP de 95% et 76%, et la VPN de 30% et 50%,respectivement. Chez les patients recrutés de manière aléatoire et avec un seuil de dépistage à 4 points plutôt que 3, la spécificité et la VPP étaient encore meilleures à 99 % et 91 % respectivement, au détriment d une baisse de la sensibilité à 12%. Chez les personnes âgées, la spécificité était de 93% et la VPP de 83% pour un seuil de dépistage à 3 points alors que ces deux valeurs étaient de 100% avec l outil au seuil de 4 points et avec le MNA. Chez les patients infectés, l efficacité de l outil était équivalente. Conclusion: Plus qu un outil de dépistage, l outil étudié s est révélé être un véritable outil diagnostique de la dénutrition, simple et rapide d utilisation, exclusivement clinique, réalisable chez tout patient et à la portée de tout soignant, donnant ainsi la possibilité d initier une prise en charge nutritionnelle précoce et adaptée.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Comparaison de 2 techniques de chirurgie de l'obésité chez des patients obèses diabétiques de type II (analyse intermédiaire de l'étude OBEDIAB)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF