title: Limited long-term survival after in-hospital intestinal failure requiring total parenteral nutrition.
abstract: BACKGROUND
  Total parenteral nutrition (TPN) is an invasive and advanced rescue feeding technique that has acceptable short-term survival although at costs of substantial risks. Survival after the clinical use of TPN >6 mo is unknown.
  
  
  OBJECTIVE
  We determined long-term survival after clinical TPN use in a consecutive cohort who were attending an academic hospital.
  
  
  METHODS
  The study included a prospective cohort with a retrospective analysis of all 537 consecutive episodes of TPN in 437 patients between January 2010 and April 2012. Follow-up was until October 2013 with a total follow-up of 608 patient-years. Survival was analyzed by using Kaplan-Meier and Cox regression.
  
  
  RESULTS
  Survival was 58% in 437 patients with a first-time use of TPN at an average of 1.5 y after the initiation of TPN. The mortality rate was 30 deaths/100 patient-years. Older age, admission at an intensive care unit or a nonsurgical department, lower body mass index, and an underlying malignancy were positively associated with mortality.
  
  
  CONCLUSIONS
  TPN use, if correctly indicated, is a clinical sign of intestinal failure and a surrogate marker for markedly increased risk of mortality even >1.5 y after TPN use. This trial was registered at clinicaltrials.gov as NCT02189993 with protocol identification name TPN-01.
authors.affiliation: From the Department of Gastroenterology and Hepatology, Small Bowel Unit (LHO and AAvB), and the Department of Clinical Nutrition and Dietetics (SMtD, SDWdG, and WA), VU University Medical Center, Amsterdam, Netherlands, and the Department of Internal Medicine, Gastroenterology and Geriatrics, ORBIS Medical Center, Sittard-Geleen, Netherlands (AAvB).
authors.forename: Leendert Harmen
authors.initials: LH
authors.lastname: Oterdoom
authors.affiliation: From the Department of Gastroenterology and Hepatology, Small Bowel Unit (LHO and AAvB), and the Department of Clinical Nutrition and Dietetics (SMtD, SDWdG, and WA), VU University Medical Center, Amsterdam, Netherlands, and the Department of Internal Medicine, Gastroenterology and Geriatrics, ORBIS Medical Center, Sittard-Geleen, Netherlands (AAvB).
authors.forename: Suzanne Marije
authors.initials: SM
authors.lastname: Ten Dam
authors.affiliation: From the Department of Gastroenterology and Hepatology, Small Bowel Unit (LHO and AAvB), and the Department of Clinical Nutrition and Dietetics (SMtD, SDWdG, and WA), VU University Medical Center, Amsterdam, Netherlands, and the Department of Internal Medicine, Gastroenterology and Geriatrics, ORBIS Medical Center, Sittard-Geleen, Netherlands (AAvB).
authors.forename: Sabine Dorine Willemine
authors.initials: SD
authors.lastname: de Groot
authors.affiliation: From the Department of Gastroenterology and Hepatology, Small Bowel Unit (LHO and AAvB), and the Department of Clinical Nutrition and Dietetics (SMtD, SDWdG, and WA), VU University Medical Center, Amsterdam, Netherlands, and the Department of Internal Medicine, Gastroenterology and Geriatrics, ORBIS Medical Center, Sittard-Geleen, Netherlands (AAvB).
authors.forename: Willy
authors.initials: W
authors.lastname: Arjaans
authors.affiliation: From the Department of Gastroenterology and Hepatology, Small Bowel Unit (LHO and AAvB), and the Department of Clinical Nutrition and Dietetics (SMtD, SDWdG, and WA), VU University Medical Center, Amsterdam, Netherlands, and the Department of Internal Medicine, Gastroenterology and Geriatrics, ORBIS Medical Center, Sittard-Geleen, Netherlands (AAvB).
authors.forename: Adriaan Anthonie
authors.initials: AA
authors.lastname: van Bodegraven
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007410:Intestinal Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000379:methods*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate