Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
JPEN J Parenter Enteral Nutr. 2023 Nov;47(8):1047-1055. doi: 10.1002/jpen.2557. Epub 2023 Sep 6.
The International Intestinal Failure Registry (IIFR) is an international consortium to study intestinal failure (IF) outcomes in a large contemporary pediatric cohort. We aimed to identify predictors of early (1-year) enteral autonomy.
We included IIFR pilot phase patients. IF was defined by a parenteral nutrition need for at least 60 days due to a primary gastrointestinal etiology. The primary outcome was time to enteral autonomy achievement. We built a mixed-effects Weibull accelerated failure time model with random effects by center to analyze variables associated with enteral autonomy achievement with a primary outcome of time ratio (TR).
We included 189 patients (82% with short bowel syndrome) representing 11 international centers. Cumulative incidence of early enteral autonomy was 51.6%, and death was 6.5%. In multivariable analysis, ostomy presence (TR, 2.63; 95% CI, 1.41-4.90) was associated with increased time to enteral autonomy achievement, and Asian/Indian (TR, 0.28; 95% CI, 0.10-0.81) and Pacific Islander race (TR, 0.34; 95% CI, 0.13-0.90) were associated with decreased time to enteral autonomy achievement. In a second model in the subset with measured percentage of bowel length remaining, ostomy presence (TR, 4.21; 95% CI, 1.90-9.33) was associated with increased time to enteral autonomy achievement, whereas greater percentage of bowel remaining (TR, 0.96; 95% CI, 0.94-0.98) was associated with decreased time to enteral autonomy achievement.
Minimizing bowel resection at initial surgery and establishing bowel continuity by ostomy reversal can effectively decrease the time to early enteral autonomy achievement in children with IF.
国际肠衰竭登记处（IIFR）是一个国际性的研究肠衰竭（IF）在大型儿科队列中结局的联盟。我们旨在确定早期（1 年）肠内自主的预测因素。
我们纳入了 IIFR 试点阶段的患者。IF 的定义为由于原发性胃肠道病因，需要至少 60 天的肠外营养。主要结局是达到肠内自主的时间。我们构建了一个带有中心随机效应的混合效应威布尔加速失效时间模型，以分析与肠内自主实现的主要结局时间比（TR）相关的变量。
我们纳入了 189 名患者（82%为短肠综合征），代表 11 个国际中心。早期肠内自主的累积发生率为 51.6%，死亡率为 6.5%。多变量分析中，造口存在（TR，2.63；95%CI，1.41-4.90）与达到肠内自主的时间延长相关，而亚洲/印度（TR，0.28；95%CI，0.10-0.81）和太平洋岛民种族（TR，0.34；95%CI，0.13-0.90）与达到肠内自主的时间缩短相关。在第二个模型中，在测量剩余肠段百分比的亚组中，造口存在（TR，4.21；95%CI，1.90-9.33）与达到肠内自主的时间延长相关，而剩余肠段百分比越大（TR，0.96；95%CI，0.94-0.98）与达到肠内自主的时间缩短相关。
在初始手术中尽量减少肠切除，并通过造口反转建立肠连续性，可以有效地缩短儿童 IF 患者早期肠内自主的时间。
