Parenteral Nutrition May Up In-Hospital Stay, Mortality in CHF Patients

CHF patients had worse outcomes with parenteral nutrition
CHF patients had worse outcomes with parenteral nutrition

This article is written live from the American Association of Clinical Endocrinologists (AACE) 2017 Annual Meeting in Austin, TX. MPR will be reporting news on the latest findings from leading experts in endocrinology. Check back for more news from AACE 2017.


According to a study presented at the AACE 2017 Annual Meeting, patients receiving parenteral nutrition had higher in-hospital mortality, morbidity, length of stay, and hospital costs when they had comorbid congestive heart failure (CHF). 

Enteral nutrition is the preferred choice when CHF patients require nutritional support. This may explain the insufficient data on the effect of CHF in patients receiving parenteral nutrition. Study authors from Icahn School of Medicine at Mount Sinai proposed that CHF could have a negative impact on outcomes in patients receiving parenteral nutrition. 

The team conducted a retrospective cohort study and included patients aged >18 years old with an ICD-9 procedural code for parenteral nutrition, and were further classified as having or not having CHF. The primary outcome was in-hospital mortality and secondary outcomes including length of hospital stay, total hospitalization charges, intensive care unit (ICU) admission, shock, and organ dysfunction. 

A total of 178,215 patients receiving parenteral nutrition were identified from the 2013 National Inpatient Sample, of which 13% (n=22,740) had comorbid CHF. Patients with CHF receiving parenteral nutrition had a greater in-hospital mortality rate vs. those without CHF (odds ratio [OR] 1.59, 95% CI: 1.44–1.75; P<0.01), a longer length of stay (2.72 days, 95% CI: 2.22–3.23, P<0.01), and greater total hospital costs ($9,211; 95% CI: $7,539–$10,882; P<0.01). 

The presence of comorbid CHF was also related to a higher rate of ICU admission (OR 2.18, 95% CI: 2.02–2.35; P<0.01), increased rate of shock (OR 1.91, 95% CI: 1.74–2.08; P<0.01) and a higher rate of organ dysfunction (OR 2.09, 95% CI: 1.94–2.25; P<0.01). 

"As we hypothesized, patients receiving PN [parenteral nutrition] who had CHF had increased in-hospital mortality compared to patients who received PN without CHF," noted lead author Carolina Hurtado, MD. The worsening clinical outcomes may be due to the concern of fluid overload for these patients with decreased cardiac function while receiving IV nutrition. 

Findings from the study "should prompt further discussion on the risks vs. benefits of parenteral nutrition in patients with CHF," concluded Dr. Hurtado.

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