Effect of individualized nutrition support on short-term outcomes of elderly patients with refractory heart failure

Abstract

Objective To explore and compare the efficacy and safety of enteral nutrition (EN),parenteral nutrition (PN),and EN + PN nutrition support on short-term outcomes of elderly patients with refractory heart failure.Methods From January 2004 to September 2012,247 elderly patients with refractory heart failure were admitted in NO.263 Clinical Department of Military General Hospital of Beijing PLA.The patients were allocated into 3 groups with random number table:the EN + PN group (n =87),the EN group (n =76),and the PN group (n =84).According to the toleration of patients to nutrition supports,5 cases were transferred to the EN + PN group,including 2 from the EN group and 3 from the PN group.The safety was assessed based on the improvement of systemic symptoms,the occurrence of adverse events,and the efficacy assessed based on serological and echocardiographic hemodynamic indexes detected before the nutrition therapy and after 7-day's nutrition support.Results Eight patients withdrew from the study,including 4 from the EN group,1from the PN group,and 3 from the EN + PN group.Compared with the levels before nutrition,serum prealbumin (PA) [EN group,(0.17 ±0.01) g/L vs.(0.11 ±0.02) g/L; PN group,(0.19 ±0.01) g/L vs.(0.09 ±0.02) g/L; EN+PN group,(0.24 ±0.04) g/L vs.(0.10 ±0.02) g/L],albumin (ALB) [EN group,(34.14 ± 1.00) g/L vs.(31.25 ± 1.02) g/L; PN group,(33.89 ± 1.20) g/L vs.(30.99 ± 1.07) g/L;EN+PN group,(36.66 ± 1.36) g/L vs.(31.00 ± 1.01) g/L],transferrin (TF) [EN group,(1.99 ±0.39) g/Lvs.(1.86±0.36) g/L;PNgroup,(2.01 ±0.41) g/Lvs.(1.89±0.34) g/L; EN+PNgroup,(2.58 ± 0.47) g/L vs.(1.92 ± 0.33) g/L] of all the 3 groups were significantly increased after nutrition (all P =0.008) ; and compared with the EN and the PN groups,PA (P =0.007 and 0.008),ALB (P =0.041and 0.040),and TF (P =0.007 and 0.008) in the EN + PN group were significantly higher.Only in the PN group,blood glucose significantly increased after nutrition support [(8.06 ± 2.35) mmol/L vs.(5.81 ±2.21) mmol/L,P=0.009].In all the 3 groups,stroke volume (SV) [EN group,(60.91 ±7.26) ml vs.(45.09±6.42) ml; PN group,(61.01 ±7.29) rml vs.(45.19 ±6.39) ml; EN +PN group,(65.42 ±7.43) ml vs.(46.11 ± 6.41) ml; all P =0.008],left ventricular ejection fraction (LVEF) [EN group,(45.78 ±0.09)％ vs.(34.61 ±0.09)％; PN group,(45.11 ±0.11)％ vs.(34.55 ±0.08)％; EN+PN group,(49.79 ± 0.11) ％ vs.(34.42 ± 0.09％ ; all P =0.008],left ventricular end-diastolic diameter (LVEdd) [EN group,(60.22 ±2.42) mm vs.(63.20 ±2.19) mm,P =0.008; PN group,(60.28 ±2.44) mmvs.(62.98 ± 2.11) mm,P=0.044; EN + PN group,(57.43 ± 2.40) mm vs.(63.09 ±2.08) mm,P =0.008],left ventricular end-systolic diameter (LVEsd) [EN group,(54.08 ± 6.06) mm vs.(56.15 ±6.03) mm,P=0.044; PNgroup,(54.42 ±6.10) mmvs.(56.31 ±6.11) mm,P=0.044;EN + PN group,(51.48 ± 5.27) mm vs.(56.32 ± 6.13) mm,P =0.008] were significantly improved after nutrition support ; compared with the EN group and the PN group,SV (P =0.003 and 0.004) and LVEF(both P =0.004) in the EN + PN group were significantly higher,while LVEdd (P =0.004 and 0.005) and LVEsd (P =0.004 and 0.005) were significantly lower.After 7-day's nutrition support,the improvement rate in EN group,PN group,and EN + PN group was 75.71％ (53/70),75.00％ (60/80),and 83.15％ (74/89),respectively.The abnormal sign scores in the 3 groups were all statistically reduced after nutrition (all P =0.000).The improvement rate in EN + PN group was higher than those in EN group and PN group (both P =0.005),but no difference between EN group and PN group (P =0.059).The degradation rate was 15.00％ in the PN group,significantly higher than those in EN group (12.85％,P =0.048) and EN +PN group (6.74％,P =0.045).During the nutrition support,the incidence of adverse events in EN + PN group was significant lower than in EN group [22.47％ (20/89) vs.37.14％ (26/70),P =0.005],but not significantly different compared with PN group [35.00％ (28/80),P =0.057].Conclusions EN + PN could elevate PA,ALB,and TF levels,alleviate clinical symptoms,and improve hemodynamics in elderly refractory heart failure patients.In addition,it has lower incidence of adverse effects than EN and PN applied alone,thus more safe and effective for these patients. Key words: Enteral nutrition combined with parenteral nutrition; Enteral nutrition; Parenteral nutrition; Heart failure ; Elderly