Comorbid Congestive Heart Failure Linked to Worse Outcomes When Receiving Parenteral Nutrition

This article is part of Endocrinology Advisor‘s coverage of the 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, taking place in Austin, Texas. Our staff will report on medical research and technological advances in diabetes, obesity, and thyroid conditions, conducted by experts in the field. Check back regularly for more news from AACE 2017.

Patients who received parenteral nutrition experienced increased negative outcomes throughout their hospital stay when they also had comorbid congestive heart failure (HF), according to research presented at the 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, May 3-7, in Austin, Texas.

Researchers from the Icahn School of Medicine at Mount Sinai in New York City conducted a retrospective cohort study examining the use of nutritional support in the care of patients with congestive HF. The primary study outcome was in-hospital mortality; secondary study outcomes were length of hospital stay, total hospitalization charges, intensive care unit admission, and rates of shock and organ dysfunction. 

Data for 179,715 patients (mean age, 62.52 years; 54% women) who received parenteral nutrition were collected from the 2013 National Inpatient Study; 12% of patients were identified as having a congestive HF diagnosis. Increased in-hospital mortality rates were noted among patients with congestive HF who were receiving parenteral nutrition (odds ratio [OR], 1.59; 95% CI, 1.44-1.75; P <.01).

These patients also experienced an increased length of stay (2.69 days; 95% CI, 2.18-3.20; P <.01) and total hospital charges ($34,455; 95% CI, $27,627-$41,283; P <.01). Increased rates of ICU admission, shock, and organ dysfunction were also noted (ORs, 2.18, 1.89, and 2.09, respectively; P <.01 for all).

“These outcomes were also translated into increased resource utilization,” the researchers wrote. “These worsening outcomes may be explained by the concern of fluid overload for these patients with reduced cardiac function while receiving [intravenous] nutrition.”

The investigators emphasized that these results should “prompt further discussion on the risks vs benefits of [parenteral nutrition] in [congestive] HF.”

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Reference

Hurtado C, Vallejo F, Kroner PT, et al. The effect of congestive heart failure in outcomes of hospitalized patients receiving parenteral nutrition. Abstract 406. Presented at: 26th Annual American Association of Clinical Endocrinologists Scientific & Clinical Congress. May 3-7, 2017; Austin, TX