Longitudinal evolution of catheter-related bloodstream infections, kidney function and liver status in a nationwide adult intestinal failure cohort

Abstract

Objectives

The development of intestinal failure-related complications in Finnish adults is unknown. This study aimed to investigate the incidence of catheter-related bloodstream infections (CRBSI), and the longitudinal changes in biochemical liver and kidney tests in a nationwide cohort.

Materials and methods

The search for Finnish adults with intestinal failure (IF) utilized a survey to Finnish health-care providers (n = 111) with the potential to provide long-term parenteral support (PS) for adult IF. Our nationwide, cross-sectional cohort included all IF patients aged ≥ 18 years who had received PS for ≥ 120 d in 2017. Data regarding CRBSI and biochemical liver and kidney tests were collected from patient records at the start of PS up to the latest available measurement in 2017.

Results

In the nationwide cohort of 52 patients, the CRBSI incidence was 1.35/1000 catheter days. Seventy-three percent of CRBSI in a long-term catheter led to catheter replacement. During a median PS duration of 27.5 (interquartile range [IQR] 11.3–57.3) months, a statistically significant median change occurred in estimated glomerular filtration rate (eGFR; −8.5 ml/min/1.73 m², IQR −30–7, p = .005) and alkaline phosphatase (ALP; 26 U/l, IQR −11–95, p = .019). In a multiple regression model for eGFR at data collection, baseline eGFR and age were strong explanatory variables.

Conclusions

Incidence of CRBSI, but not treatment strategies, in this nationwide adult IF population correspond well to those reported from specialized centers. Decreased kidney function and abnormal liver test results are frequent findings, and even more so over time, emphasizing the importance of regular monitoring.

Keywords:

• Short bowel syndrome
• renal failure
• IFALD
• home parenteral nutrition
• CRBSI

Acknowledgments

The authors thank Nina Lundbom, Eero Sopanen and Pasi Aronen for their contributions to the study. The authors also thank all healthcare professionals who responded to our survey.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Sigrid Juselius Foundation, the Finnish Pediatric Research Foundation, the Helsinki University Hospital (grants to MPP), the Finnish Cultural Foundation (grant to AKP), the Mary och Georg C. Ehrnrooths Stiftelse (grant to TMS) and Suomen Kulttuurirahasto.