在姑息治疗患者中，肾功能恶化与肠外营养依赖生存相关。
Kidney Function Worsening Is Linked to Parenteral-Nutrition-Dependent Survival in Palliative Care Patients.
机构信息
Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, 1090 Vienna, Austria.
Institute for Vascular Biology, Centre for Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria.
出版信息
Nutrients. 2022 Feb 11;14(4):769. doi: 10.3390/nu14040769.
BACKGROUND
Parenteral nutrition (PN) is frequently administered in palliative care patients suffering from cachexia. The evidence regarding the use of PN in terminally ill patients is scarce. Routine laboratory parameters might help to decide whether to start or forgo PN, which could decrease overtreatment at the end of life. Kidney failure was frequently associated with survival. However, a relation between kidney function parameters and parenteral nutrition has not been observed thus far. The aim of this retrospective cohort study was to analyze kidney function parameters in palliative care patients under PN, as well as the relation between these parameters and overall survival.
METHODS
Patients who were admitted to the Department of Palliative Medicine at the Medical University of Vienna were screened for PN treatment. Whether kidney function parameters at baseline or their dynamics over the course of two weeks were associated with survival was assessed with descriptive and interferential statistics.
RESULTS
In total, 113 of 443 palliative care patients were administered parenteral nutrition for the first time. The overall survival (OS) for all patients with increased kidney function parameters at baseline was lower (creatinine: hazard ratio (HR) = 1.808, < 0.001; urea: HR = 1.033, < 0.001; uric acid HR = 1.055, = 0.015). No significant increase in creatinine blood levels was observed in the first 2 weeks after the initiation of PN when compared to the non-PN group ( = 0.86). However, if creatinine blood levels increased within the PN group, lower overall survival was found (HR = 2.046, = 0.007).
CONCLUSION
Increased kidney function parameters, such as creatinine, urea and uric acid, might be used as negative prognostic markers in palliative care patients under PN. Moreover, an increase in creatinine during the administration of parenteral nutrition in the first 2 weeks is linked to worse outcomes. These findings may help future studies to establish objective markers for clinicians to determine whether to start or end PN in palliative cancer patients and decrease potential overtreatment at the end of life.
背景
在患有恶病质的姑息治疗患者中，经常给予肠外营养（PN）。在终末期患者中使用 PN 的证据很少。常规实验室参数有助于决定是否开始或放弃 PN，可以减少生命末期的过度治疗。肾衰竭常与生存相关。然而，到目前为止，尚未观察到肾功能参数与肠外营养之间的关系。本回顾性队列研究的目的是分析接受 PN 的姑息治疗患者的肾功能参数，以及这些参数与总生存之间的关系。
方法
筛选维也纳医科大学姑息医学系收治的接受 PN 治疗的患者。使用描述性和干预性统计方法评估基线时的肾功能参数或两周内的变化与生存的关系。
结果
共有 443 例姑息治疗患者中，有 113 例首次接受肠外营养治疗。所有基线时肾功能参数升高的患者的总体生存率（OS）较低（肌酐：危险比（HR）= 1.808，< 0.001；尿素：HR = 1.033，< 0.001；尿酸 HR = 1.055，= 0.015）。与非 PN 组相比，PN 开始后前 2 周内肌酐血水平无明显升高（= 0.86）。然而，如果 PN 组内肌酐血水平升高，则发现总体生存率较低（HR = 2.046，= 0.007）。
结论
升高的肾功能参数，如肌酐、尿素和尿酸，可作为接受 PN 的姑息治疗患者的负预后标志物。此外，PN 治疗的前 2 周内肌酐增加与结局较差相关。这些发现可能有助于未来的研究为临床医生建立客观标志物，以确定在姑息治疗癌症患者中是否开始或结束 PN，并减少生命末期潜在的过度治疗。
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