Determinants of home parenteral nutrition dependence and survival of 268 patients with non-malignant short bowel syndrome

Abstract

Short bowel syndrome (SBS) is a rare and severe condition where home parenteral nutrition (HPN) dependence can be either permanent or transient. The timing of HPN discontinuation and the survival, according to SBS characteristics, need to be further reported to help plan pre-emptive intestinal transplantation and reconstructive surgery. 268 Non-malignant SBS patients have been followed in our institution since 1980. HPN dependence and survival rate were studied with univariate and multivariate analysis. Median follow-up was 4.4 (0.3-24) years. Actuarial HPN dependence probabilities were 74%, 64%and 48% at 1, 2 and 5 years, respectively. In multivariate analysis, HPN dependence was significantlydecreased with an early (<6mo) plasma citrulline concentration >20μmol/l, a remaining colon >57% (4/7) and a remnant small bowel length >75cm. Among the 124 patients who became HPN independent, 26.5% did so more than 2 years after SBS constitution. This study indicates that long-term HPN is required in 47% of SBS patients started on this therapy. HPN independence is significantly associated with the remnant small bowel length, remaining colon and early plasma citrulline concentration. Noteworthy, HPN dependence could be reversed until 5 years after SBS constitution.