Clinical outcomes in Crohn's disease patients with short bowel syndrome on home parenteral nutrition are comparable to those with short bowel syndrome from other etiologies

Background & aims

Patients with short bowel syndrome (SBS) and chronic intestinal failure require home parenteral nutrition (PN) support. The main cause of SBS remains Crohn's disease (CD), and complications in this cohort versus SBS from other etiologies remains to be determined. We therefore sought to investigate whether patients with SBS secondary to CD versus SBS secondary to other etiologies, have increased risk of complications and whether there is a difference in overall mortality between groups.

Methods

This is a multicentre prospective cohort study using the Canadian Home Parenteral Nutrition (HPN) Registry. Two groups were compared: 1) SBS secondary to CD (SBS-CD) vs. 2) SBS- secondary to other etiologies (SBS-Other) (including trauma, surgical complication, vascular event, volvulus and malignancy). Clinical data for each patient included: number of hospitalizations, number of hospitalizations related to HPN and number of hospitalization days related to HPN, incidence of line sepsis per 1000 catheter days and mortality. Descriptive statistics are presented as median (interquartile range) for continuous variables and as frequency (percentage) for categorical variables as appropriate. Comparison between groups were performed using a 2-sample t-test,Poisson regression analysis or Wilcoxon rank sum test for continuous variables and Chi-square or Fisher exact tests when appropriate for categorical variables. Kaplan-Meir curve and multivariate analysis was performed to assess mortality. Statistical significance is set at a p-value <0.05.

Results

The study included 383 patients with SBS and intestinal failure: 172 (45 %) SBS-CD and 211 (55 %) SBS-Other; followed for median of 4 (2, 6) years and 2 (2, 4) years respectively (p = 0.027). The groups were comparable at baseline except for younger age, shorter small bowel length and medications with higher use of immunosuppressant therapy (39 % vs. 7 %, p < 0.001) in those with CD. The number of hospitalizations, hospitalization days, and line sepsis per 1000 catheter days were similar amongst the SBS- CD and SBS-Other (p > 0.05 across all primary outcomes). Mortality events were also similar between groups (31 patients (26.72 %) in SBS CD group vs. 37 patients (29.84 %) in SBS- Other group, p = 0.6676). The Kaplan-Meir curve did not show a statistical difference in mortality between groups but a multivariate analysis of the entire patient population showed that age was associated with mortality. In subgroup analysis, patients with SBS- CD taking immunosuppressant therapy were not at higher risk of hospitalizations or line sepsis compared to those not on immunomodulating therapies (0.50 versus 1.57 p = 0.0417).

Conclusion

Individuals with SBS CD do not have increased risk of hospitalizations, central line infections or mortality compared to those with SBS from other causes. In CD, those on immunomodulating therapies do not appear to be at increased risk of complications.