Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
JPEN J Parenter Enteral Nutr. 2021 Jul;45(5):1100-1107. doi: 10.1002/jpen.1988. Epub 2020 Sep 10.
Despite advances in the medical management of inflammatory bowel disease (IBD), a subset of patients may require extensive surgery, leading to short-bowel syndrome/intestinal failure requiring long-term home parenteral nutrition (PN) or customized intravenous fluid (IVF) support. Our aim was to further define the characteristics of IBD patients requiring home PN/IVF.
This is an observational study from a prospective IBD research registry. Patients receiving long-term home PN/IVF support during 2009-2015 were identified and compared with remaining IBD patients. Demographics, surgical history, smoking, narcotic use, IBD treatment, healthcare charges, and presence of biomarkers were reviewed. The IBD-PN group was stratified into 3 groups based on median healthcare charges.
Of 2359 IBD patients, there were 25 (1%, 24 with Crohn's disease) who required home PN/IVF, and 250 randomly selected IBD patients matched for disease type formed the control population. Median duration of PN use was 27 months (interquartile range, 11-66). PN use was significantly associated with smoking, narcotic use, IBD-related operations, and lower quality-of-life scores. Among IBD-PN patients, 7 of 25 (28%, 3 after use of teduglutide) were able to successfully discontinue this modality. Median healthcare charges in the IBD-PN group were $51,456 annually. Median charges in the controls were $3427. Period prevalence mortality was 11.5% in IBD-PN and 3.8% in controls.
IBD patients requiring long-term home PN/IVF support are a small minority in the present era of immunomodulator/biologic therapy. These refractory patients have a 15-fold increase in annual median healthcare charges compared with control IBD patients.
尽管炎症性肠病（IBD）的医学治疗取得了进展，但仍有一部分患者可能需要广泛的手术，导致短肠综合征/肠衰竭，需要长期家庭肠外营养（PN）或定制静脉输液（IVF）支持。我们的目的是进一步确定需要家庭 PN/IVF 的 IBD 患者的特征。
这是一项来自前瞻性 IBD 研究登记处的观察性研究。在 2009 年至 2015 年间，确定了接受长期家庭 PN/IVF 支持的患者，并与其余 IBD 患者进行了比较。回顾了人口统计学、手术史、吸烟、使用麻醉剂、IBD 治疗、医疗费用和生物标志物的存在情况。根据医疗费用中位数，将 IBD-PN 组分为 3 组。
在 2359 例 IBD 患者中，有 25 例（1%，其中 24 例为克罗恩病）需要家庭 PN/IVF，随机选择 250 例 IBD 患者作为对照组，疾病类型匹配。PN 使用的中位时间为 27 个月（四分位间距，11-66）。PN 使用与吸烟、使用麻醉剂、IBD 相关手术和较低的生活质量评分显著相关。在 IBD-PN 患者中，有 7 例（28%，3 例在使用 teduglutide 后）成功停用了该治疗方法。IBD-PN 组的年医疗费用中位数为 51456 美元。对照组的中位数为 3427 美元。IBD-PN 组的期间患病率死亡率为 11.5%，对照组为 3.8%。
在当前免疫调节剂/生物治疗时代，需要长期家庭 PN/IVF 支持的 IBD 患者为数较少。与对照 IBD 患者相比，这些难治性患者的年医疗费用中位数增加了 15 倍。
