Body composition predicts clinical outcome in patients with intestinal failure on long-term home parenteral nutrition

Abstract

Patients with chronic intestinal failure (CIF) are at risk of altered body composition and impaired muscle function, which may negatively affect clinical outcome. The aim of this study was to investigate the predictive value of body composition and muscle strength in relation to clinical outcome in CIF patients on long-term home parenteral nutrition (HPN). This was an observational cohort study comprising 77 clinically stable patients with CIF on HPN (>12 months). At inclusion, we recorded demographic data and information regarding anthropometry, body composition assessed by bioelectrical impedance and muscle strength by hand grip strength. Number of yearly hospital readmissions and length of hospital stay (LOS) as well as all-cause mortality characterized clinical outcome. Assessment parameters were categorized according to normative reference values. The average number of readmissions was 2.0±1.8 per year and the average LOS was 23.2±23.6 days. In univariate analysis phase angle (PA, p=0.009) and handgrip strength (HGS, p=0.012) were associated with the number of readmissions. Multivariate analysis confirmed the independence and significance of the association for PA (coefficient-0.5 [95% CI;-0.9 to-0.2]; p=0.007). In addition, PA was associated with LOS in univariate analysis (p=0.019), while none of the remaining parameters were significantly associated with LOS. During the follow-up period (median 24.3 months), 16 (20.8%) patients died and the cumulative mortality rate was 14.3% after two years. Fat free mass index (FFMI) below normal (Hazard Ratio 3.9 [95% CI; 1.1-14.1]; p=0.04) and PA below normal (Hazard Ratio 5.3 [95% CI; 1.6-17.5]; P=0.007) were identified as independent risk factors for mortality. Phase angle significantly predicted number of readmissions, length of hospital stay and mortality in patients with intestinal failure on long-term parenteral nutrition, while fat free mass index only predicted mortality.