Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in older persons with dysphagia: A propensity-matched cohort study
Autoři:
Shigenori Masaki aff001; Takashi Kawamoto aff002
Působiště autorů:
Shigenori Masaki, Department of Surgery and Gastroenterology, Miyanomori Memorial Hospital, Sapporo, Hokkaido, Japan
aff001; Takashi Kawamoto, Department of Neurosurgery, Miyanomori Memorial Hospital, Sapporo, Hokkaido, Japan
aff002
Vyšlo v časopise:
PLoS ONE 14(10)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0217120
Souhrn
Background
The long-term outcomes of artificial nutrition in older people with dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy (PEG) is one of the major methods of artificial nutrition. Enteral feeding is indicated for patients with a functional gastrointestinal tract. However, total parenteral nutrition (TPN) is often inappropriately chosen for artificial nutrition in Japan, even in patients with a functional gastrointestinal tract, as PEG has recently been viewed as an unnecessary life-prolonging treatment in Japan. This study aimed to compare the long-term outcomes between PEG and TPN.
Methods
This single-center retrospective cohort study investigated long-term outcomes in older patients with dysphagia who received PEG or TPN between January 2014 and January 2017. The primary outcome was survival time. Secondary outcomes were oral intake recovery, discharge to home, and the incidence of severe pneumonia and sepsis. We performed 1-to-1 propensity score matching using a 0.05 caliper. The Kaplan–Meier method, log-rank test, and Cox regression analysis were used to compare the survival time between groups.
Results
We identified 253 patients who received PEG (n = 180) or TPN (n = 73). Older patients, those with lower nutritional states, and severe dementia were more likely to receive TPN. Propensity score matching created 55 pairs. Survival time was significantly longer in the PEG group (median, 317 vs 195 days; P = 0.017). The hazard ratio for PEG relative to TPN was 0.60 (95% confidence interval: 0.39–0.92; P = 0.019). There were no significant differences between the groups in oral intake recovery and discharge to home. The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 25.5%, P = 0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 30.9%, P = 0.018).
Conclusions
PEG was associated with a significantly longer survival time, a higher incidence of severe pneumonia, and a lower incidence of sepsis compared with TPN.
Klíčová slova:
C-reactive proteins – Dementia – Japan – Pneumonia – Sepsis – Dysphagia – Serum albumin
Zdroje
1. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980; 15: 872–875. doi: 10.1016/s0022-3468(80)80296-x 6780678
2. Ponsky JL, Gauderer MW. Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy. Gastrointest Endosc. 1981; 27: 9–11. doi: 10.1016/s0016-5107(81)73133-x 6783471
3. Gomes CA Jr, Andriolo RB, Bennett C, Lustosa SA, Matos D, Waisberg DR, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev. 2015; 5: CD008096.
4. Jaafar MH, Mahadeva S, Tan KM, Chin AV, Kamaruzzaman SB, Khor HM, et al. Long-Term Nasogastric Versus Percutaneous Endoscopic Gastrostomy Tube Feeding in Older Asians With Dysphagia: A Pragmatic Study. Nutr Clin Pract. 2019; 34: 280–289. doi: 10.1002/ncp.10195 30251336
5. Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA. 1999; 282: 1365–1370. doi: 10.1001/jama.282.14.1365 10527184
6. Sanders DS, Carter MJ, D' Silva J, James G, Bolton RP, Bardhan KD. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol. 2000; 95: 1472–1475. doi: 10.1111/j.1572-0241.2000.02079.x 10894581
7. Takayama K, Hirayama K, Hirao A, Kondo K, Hayashi H, Kadota K, et al. Survival times with and without tube feeding in patients with dementia or psychiatric diseases in Japan. Psychogeriatrics. 2017; 17: 453–459. doi: 10.1111/psyg.12274 29178502
8. Dudrick SJ, Copeland EM 3rd, Daly JM, Long JM 3rd, Duke JH Jr, MacFadyen BV Jr, et al. A clinical review of nutritional support of the patient. JPEN J Parenter Enteral Nutr. 1979; 3: 444–451. doi: 10.1177/014860717900300608 119063
9. Wanten G, Calder PC, Forbes A. Managing adult patients who need home parenteral nutrition. BMJ. 2011; 342: d1447. doi: 10.1136/bmj.d1447 21421667
10. Abe K, Yamashita R, Kondo K, Takayama K, Yokota O, Sato Y, et al. Long-Term Survival of Patients Receiving Artificial Nutrition in Japanese Psychiatric Hospitals. Dement Geriatr Cogn Dis Extra. 2016; 6: 477–485. doi: 10.1159/000448242 27843445
11. Worthington P, Balint J, Bechtold M, Bingham A, Chan LN, Durfee S, et al. When Is Parenteral Nutrition Appropriate? JPEN J Parenter Enteral Nutr. 2017; 41: 324–377. doi: 10.1177/0148607117695251 28333597
12. Sudo K, Kobayashi J, Noda S, Fukuda Y, Takahashi K. Japan's healthcare policy for the elderly through the concepts of self-help (Ji-jo), mutual aid (Go-jo), social solidarity care (Kyo-jo), and governmental care (Ko-jo). Biosci Trends. 2018; 12: 7–11. doi: 10.5582/bst.2017.01271 29479017
13. Japanese Geriatric Society Ethics Committee, Iijima S, Aida N, Ito H, Endo H, Ohrui T, et al. Position statement from the Japan Geriatrics Society 2012: End-of-life care for the elderly. Geriatr Gerontol Int. 2014; 14: 735–739. 25489649
14. Ministry of Health, Labour and Welfare: “Shinryo¯ho¯shu¯kaitei ni tsuite” (Revision of medical fee). Available from: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000032996.html (2014). [cited 13 June 2019] (in Japanese).
15. Komiya K, Usagawa Y, Kadota J, Ikegami N. Decreasing Use of Percutaneous Endoscopic Gastrostomy Tube Feeding in Japan. J Am Geriatr Soc. 2018; 66: 1388–1391. doi: 10.1111/jgs.15386 29799111
16. Cham H, West SG. Propensity score analysis with missing data. Psychol Methods. 2016; 21: 427–445. doi: 10.1037/met0000076 26962757
17. Shigoka H, Maetani I, Tominaga K, Gon K, Saitou M, Takenaka Y. Comparison of modified introducer method with pull method for percutaneous endoscopic gastrostomy: prospective randomized study. Dig Endosc. 2012; 24: 426–431. doi: 10.1111/j.1443-1661.2012.01317.x 23078434
18. Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: A review. Eur J Intern Med. 2016; 31: 3–10. doi: 10.1016/j.ejim.2016.03.007 27039014
19. Ministry of Health, Labour and Welfare: “Shinryo¯ho¯shu¯kaitei ni tsuite” (Revision of medical fee). Available from: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000188411.html (2018). [cited 13 June 2019] (in Japanese).
20. Corona LP, de Oliveira Duarte YA, Lebrão ML. Markers of nutritional status and mortality in older adults: The role of anemia and hypoalbuminemia. Geriatr Gerontol Int. 2018; 18: 177–182. doi: 10.1111/ggi.13137 28782162
21. Suzuki S, Tamez S, Murakami A, Taira A, Mizuhara A, Horiuchi A, et al. Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan. World J Gastroenterol. 2010; 16: 5084–5091. doi: 10.3748/wjg.v16.i40.5084 20976846
22. Barbosa M, Magalhaes J, Marinho C, Cotter J. Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein. Clin Nutr ESPEN. 2016; 14: 19–23. doi: 10.1016/j.clnesp.2016.04.029 28531394
23. Sun X, Luo L, Zhao X, Ye P. Controlling Nutritional Status (CONUT) score as a predictor of all-cause mortality in elderly hypertensive patients: a prospective follow-up study. BMJ Open. 2017; 7: e015649. doi: 10.1136/bmjopen-2016-015649 28928176
24. Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991; 10: 585–598. doi: 10.1002/sim.4780100410 2057657
25. Li P, Stuart EA, Allison DB. Multiple Imputation: A Flexible Tool for Handling Missing Data. JAMA. 2015; 314: 1966–1967. doi: 10.1001/jama.2015.15281 26547468
26. Stürmer T, Joshi M, Glynn RJ, Avorn J, Rothman KJ, Schneeweiss S. A review of the application of propensity score methods yielded increasing use, advantages in specific settings, but not substantially different estimates compared with conventional multivariable methods. J Clin Epidemiol. 2006; 59: 437–447. doi: 10.1016/j.jclinepi.2005.07.004 16632131
27. Lunt M. Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching. Am J Epidemiol. 2014; 179: 226–235. doi: 10.1093/aje/kwt212 24114655
28. Wang Y, Cai H, Li C, Jiang Z, Wang L, Song J, et al. Optimal caliper width for propensity score matching of three treatment groups: a Monte Carlo study. PLoS One. 2013; 8: e81045. doi: 10.1371/journal.pone.0081045 24349029
29. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplantation. 2013; 48: 452–458. doi: 10.1038/bmt.2012.244 23208313
30. Bito S, Yamamoto T, Tominaga H. Prospective cohort study comparing the effects of different artificial nutrition methods on long-term survival in the elderly: Japan Assessment Study on Procedures and Outcomes of Artificial Nutrition (JAPOAN). JPEN J Parenter Enteral Nutr. 2015; 39: 456–464.
31. Tamiya H, Yasunaga H, Matusi H, Fushimi K, Akishita M, Ogawa S. Comparison of short-term mortality and morbidity between parenteral and enteral nutrition for adults without cancer: a propensity-matched analysis using a national inpatient database. Am J Clin Nutr. 2015; 102: 1222–1228. doi: 10.3945/ajcn.115.111831 26447149
32. Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr. 2001; 74: 534–542. doi: 10.1093/ajcn/74.4.534 11566654
33. McClave SA, DiBaise JK, Mullin GE, Martindale RG. ACG clinical guideline: nutrition therapy in the adult hospitalized patient. Am J Gastroenterol. 2016; 111: 315–334. doi: 10.1038/ajg.2016.28 26952578
34. Volkert D, Chourdakis M, Faxen-Irving G, Frühwald T, Landi F, Suominen MH, et al. ESPEN guidelines on nutrition in dementia. Clin Nutr. 2015; 34: 1052–1073. doi: 10.1016/j.clnu.2015.09.004 26522922
35. American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee. American Geriatrics Society feeding tubes in advanced dementia position statement. J Am Geriatr Soc. 2014; 62: 1590–1593. doi: 10.1111/jgs.12924 25039796
36. Druml C, Ballmer PE, Druml W, Oehmichen F, Shenkin A, Singer P, et al. ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clin Nutr. 2016; 35: 545–556. doi: 10.1016/j.clnu.2016.02.006 26923519
37. Orlandoni P, Peladic NJ, Di Rosa M, Venturini C, Fagnani D, Sparvoli D, et al. The outcomes of long term home enteral nutrition (HEN) in older patients with severe dementia. Clin Nutr. 2019; 38: 1871–1876. doi: 10.1016/j.clnu.2018.07.010 30061054
38. Nakadate A, Otaka Y, Kondo K, Yamamoto R, Matsuura D, Honaga K, et al. Age, body mass index, and white blood cell count predict the resumption of oral intake in subacute stroke patients. J Stroke Cerebrovasc Dis. 2016; 25: 2801–2808. doi: 10.1016/j.jstrokecerebrovasdis.2016.07.038 27542695
39. Ikenaga Y, Nakayama S, Taniguchi H, Ohori I, Komatsu N, Nishimura H, et al. Factors predicting recovery of oral intake in stroke survivors with dysphagia in a convalescent rehabilitation ward. J Stroke Cerebrovasc Dis. 2017; 26: 1013–1019. doi: 10.1016/j.jstrokecerebrovasdis.2016.12.005 28108097
40. Ross VM, Guenter P, Corrigan ML, Kovacevich D, Winkler MF, Resnick HE, et al. Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care. Am J Infect Control. 2016; 44: 1462–1468. doi: 10.1016/j.ajic.2016.06.028 27908433
41. Chopra V, Ratz D, Kuhn L, Lopus T, Chenoweth C, Krein S. PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med. 2014; 127: 319–328. doi: 10.1016/j.amjmed.2014.01.001 24440542
42. MacFie J. Enteral versus parenteral nutrition: the significance of bacterial translocation and gut-barrier function. Nutrition. 2000; 16: 606–611. doi: 10.1016/s0899-9007(00)00249-5 10906570
43. Kovacevich DS, Corrigan M, Ross VM, McKeever L, Hall AM, Braunschweig C. American Society for Parenteral and Enteral Nutrition Guidelines for the Selection and Care of Central Venous Access Devices for Adult Home Parenteral Nutrition Administration. JPEN J Parenter Enteral Nutr. 2019; 43: 15–31. doi: 10.1002/jpen.1455 30339287
44. Santacruz E, Mateo-Lobo R, Riveiro J, Nattero L, Vega-Piñero B, Lomba G, et al. Infectious complications in home parenteral nutrition: A long-term study with peripherally inserted central catheters, tunneled catheters, and ports. Nutrition. 2019; 58: 89–93. doi: 10.1016/j.nut.2018.06.016 30391696
Článek vyšel v časopise
PLOS One
2019 Číslo 10
- S diagnostikou Parkinsonovy nemoci může nově pomoci AI nástroj pro hodnocení mrkacího reflexu
- Je libo čepici místo mozkového implantátu?
- Pomůže v budoucnu s triáží na pohotovostech umělá inteligence?
- AI může chirurgům poskytnout cenná data i zpětnou vazbu v reálném čase
- Nová metoda odlišení nádorové tkáně může zpřesnit resekci glioblastomů
Nejčtenější v tomto čísle
- Correction: Low dose naltrexone: Effects on medication in rheumatoid and seropositive arthritis. A nationwide register-based controlled quasi-experimental before-after study
- Combining CDK4/6 inhibitors ribociclib and palbociclib with cytotoxic agents does not enhance cytotoxicity
- Experimentally validated simulation of coronary stents considering different dogboning ratios and asymmetric stent positioning
- Risk factors associated with IgA vasculitis with nephritis (Henoch–Schönlein purpura nephritis) progressing to unfavorable outcomes: A meta-analysis
Zvyšte si kvalifikaci online z pohodlí domova
Všechny kurzy