炎性肠病成年患者接受肠外营养支持的全国趋势和住院结局

　　炎性肠病包括克罗恩病和溃疡性结肠炎，患者容易因经口摄入减少、吸收不良、代谢消耗增加，引发蛋白-热量营养不良。

　　加利福尼亚大学欧文分校、退伍军人事务部长滩医疗保健系统、密苏里大学为了评估美国全国炎性肠病住院患者肠外营养使用率并明确其住院结局，对1998～2006年全国住院患者样本库进行了分析，以确定溃疡性结肠炎或克罗恩病患者的肠外营养应用率，同时明确其住院结局，并对可增加该人群住院患者死亡率的可疑因素进行了多变量分析。

　　结果发现，1998～2006年克罗恩病住院患者肠外营养年应用率为十万分之4.29，溃疡性结肠炎患者为十万分之3.80，这种趋势在此期间相对稳定。接受肠外营养的溃疡性结肠炎患者与克罗恩病患者相比，平均住院时间较长。预期增加死亡率的风险因素包括：年龄＞50岁、急性肾损伤、医院获得性肺炎、艰难梭菌结肠炎、术后肠梗阻时间延长导致应用肠外营养、肺栓塞、营养不良、溃疡性结肠炎患者（相比克罗恩病患者）。

　　因此，克罗恩病患者与溃疡性结肠炎患者相比，发生营养不良的风险通常较高；然而，溃疡性结肠炎患者与克罗恩病患者相比，住院期间死亡风险高2倍、住院时间延长。该模式提示肠外营养的应用，尤其在溃疡性结肠炎患者中，可作为较高疾病敏感性和严重性的替代标志。

JPEN J Parenter Enteral Nutr. 2016;40(3):412-6.

National Trends and In-Hospital Outcomes of Adult Patients With Inflammatory Bowel Disease Receiving Parenteral Nutrition Support.

Nguyen DL, Parekh N, Bechtold ML, Jamal MM.

University of California, Irvine, Orange, California; Veterans Affairs Long Beach Health Care Systems, Long Beach, California; University of Missouri-Columbia, Columbia, Missouri.

BACKGROUND: Patients with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are susceptible to protein-calorie malnutrition secondary to decreased oral intake, malabsorption, and increased metabolic expenditure. In this study, we seek to assess the national frequencies of parenteral nutrition (PN) use among hospitalized patients with IBD and to determine their in-hospital outcomes.

METHODS: We analyzed the Nationwide Inpatient Sample from 1988-2006 to determine the frequency of PN usage among patients with UC or CD and to determine their in-hospital outcomes. A multivariate analysis was performed to identify factors predictive of increased inpatient mortality in this population.

RESULTS: From 1988-2006, the annual incidence of PN use among hospitalized patients with CD was 4.29 per 100,000 and among those with UC was 3.80 per 100,000, with trends being relatively stable through the indexed period. The mean length of hospitalization among patients with UC receiving PN was longer compared with patients with CD. Factors predictive of an increased risk for mortality include the following: age >50 years, acute kidney injury, hospital-acquired pneumonia, Clostridium difficile colitis, prolonged postoperative ileus requiring PN use, pulmonary embolism, malnutrition, and patients with UC relative to CD.

CONCLUSION: Traditionally, patients with CD are at a higher risk for developing malnutrition than patients with UC; however, there is a 2-fold higher risk for inpatient mortality and a longer length of hospitalization among patients with UC compared with those with CD. This pattern suggests that the use of PN, particularly among patients with UC, serves as a surrogate marker of higher disease acuity and severity.

KEYWORDS: hospitalized patients; inflammatory bowel disease; parenteral nutrition

PMID: 24687967

DOI: 10.1177/0148607114528715