Nutritional treatment is associated with longer survival in patients with pancreatic disease and concomitant risk of malnutrition

Mari Rivelsrud; Ingvild Paur; Kari Sygnestveit; Roy M Nilsen; Randi J Tangvik

doi:10.1016/j.clnu.2020.09.037

Nutritional treatment is associated with longer survival in patients with pancreatic disease and concomitant risk of malnutrition

Clin Nutr. 2021 Apr;40(4):2128-2137. doi: 10.1016/j.clnu.2020.09.037. Epub 2020 Oct 1.

Authors

Mari Rivelsrud¹, Ingvild Paur², Kari Sygnestveit³, Roy M Nilsen⁴, Randi J Tangvik⁵

Affiliations

¹ Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
² Norwegian Advisory Unit on Disease-Related Undernutrition, Oslo University Hospital, Norway.
³ Norwegian Advisory Unit on Disease-Related Undernutrition, Oslo University Hospital, Norway; Department of Research and Development, Haukeland University Hospital, Norway.
⁴ Department of Research and Development, Haukeland University Hospital, Norway; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien, 28, 5063, Bergen, Norway.
⁵ Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway; Department of Research and Development, Haukeland University Hospital, Norway. Electronic address: Randi.Tangvik@uib.no.

PMID: 33059912
DOI: 10.1016/j.clnu.2020.09.037

Abstract

Background: Pancreatic diseases involve complex nutritional challenges. Despite this, conflicting evidence exists regarding the clinical relevance of detecting the risk of malnutrition and implementing systematic nutrition support for these patients. Thus, our aims were to investigate whether screening for malnutrition risk and initiating nutrition support are predictive of mortality for hospitalized patients with pancreatic diseases.

Design: From 2008 to 2018, 34 prevalence surveys of nutrition were conducted at Haukeland University Hospital (HUH), Norway. Risk of malnutrition was defined by a score of ≥3 in Nutritional Risk Screening 2002 (NRS 2002). Primary outcomes included overall, one-year, and one-month mortality, and were compared according to malnutrition risk and nutrition support for adult patients with ICD-10 codes of K85: acute pancreatitis, K86: other diseases of pancreas, and C25: malignant neoplasm of pancreas. Length of hospital stay (LOS) was included as a secondary outcome.

Results: Of the 283 patients investigated, risk of malnutrition was present in 61.5%. Risk of malnutrition was associated with higher overall mortality (Hazard Ratio (HR) = 1.67, 95% confidence interval (CI): 1.2-2.4, P = 0.003) and one-year mortality (HR = 1.89, 95% CI: 1.2-2.9, P = 0.004) compared to patients not at risk. Not receiving nutrition support for at-risk patients was associated with higher overall mortality (HR = 1.60, 95% CI: 1.1-2.4, P = 0.019) and one-year mortality (HR = 1.64, 95% CI: 1.04-2.6, P = 0.034) compared to patients at risk who received nutrition support. Patients at risk of malnutrition had increased LOS (20.5 nights vs 15.2 nights, P = 0.044) compared to patients not at risk of malnutrition.

Conclusion: This study of hospitalized patients with pancreatic disease suggests that risk of malnutrition may be associated with higher mortality rates, whereas nutrition support may decrease mortality rates.

Clinical trial registry: Not registered.

Keywords: Acute pancreatitis; Chronic pancreatitis; Malnutrition; NRS 2002; Nutrition treatment; Pancreatic malignancies.

MeSH terms

Adult
Aged
Female
Humans
Length of Stay
Male
Malnutrition / diagnosis
Malnutrition / epidemiology*
Mass Screening
Middle Aged
Norway / epidemiology
Nutrition Assessment
Nutritional Support / methods
Nutritional Support / statistics & numerical data*
Pancreatic Diseases / mortality*
Pancreatic Diseases / therapy*
Pancreatic Neoplasms
Pancreatitis / mortality
Pancreatitis / therapy
Proportional Hazards Models
Risk Factors
Survival Rate