THE CAUSE OF DEATH IN PATIENTS ON HOME PARENTERAL NUTRITION IN THE NORTH-EAST OF ENGLAND

Introduction Home total parenteral nutrition (HPN) is indicated for patients with severe intestinal failure. The service at the Freeman Hospital, Newcastle upon Tyne covers a wide area encompassing Northumberland, North Cumbria, Durham, Gateshead, North Yorkshire, Tyneside, Wearside and Teesside. A previous European study.1 had suggested deaths in HPN patients after 2 years of HPN were most likely due to PN. The aim of our study was to determine whether the cause of mortality for patients who had been under our service for HPN was linked to complications of HPN therapy. Methods This study retrospectively looked at all patients who were started on HPN by the service from 1996 until August 2018 and identified all patients who had died. The case notes were reviewed and if the cause of death was not clear from the notes, their general practitioner (GP) surgery was contacted to gain further information. Results 88 patients were identified as having died whilst or after being on HPN. The mean age was 58 years old and their average time on HPN was 25 months. There was an even gender split of 44 in each category. The three most common categories for HPN indication for the patients were cancer (32/88, 36%), inflammatory bowel disease (13/88, 15%) and mesenteric ischaemia (11/88, 13%). Most of the deaths were attributed to cancer (45/88, 51%) and non-PN/non-malignant related (29/88, 33%). There were two deaths attributed to complications of being on parenteral nutrition. For nine cases, GP surgeries did not have any further information on cause of death. We did not receive a response regarding three patients despite contacting GP surgeries Table 1 showing cause of death according to number of years on PN The table above reveals that as time on HPN increased the commonest cause of mortality changes from cancer to non-PN related complications. On review of the patients whose cause of death were attributed to cancer, 12 did not have malignancy as initial HPN indication. Regarding mortality not linked to HPN, respiratory complications including pneumonia were the commonest causative factor (8/29, 28%). Conclusions This study showed that mortality was associated with the underlying disease condition resulting in the need for HPN or other co-morbidities rather than direct complications of HPN itself. Reference Pironi L, Joly F, Forbes A, et al. Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation. Gut 2011;60:1–5.