Routine laboratory parameters to support decision on parenteral nutrition in palliative care

Lea Kum; Elisabeth L Zeilinger; Dagmar Vohla; Anna Kitta; Nadine Brunevskaya; Feroniki Adamidis; Franziska Ecker; Eva K Masel; Brigitte Mayr-Pirker; Alexa L Meyer; Bärbel Sturtzel; Gudrun Kreye; Matthias Unseld

doi:10.3389/fnut.2023.1173106

Routine laboratory parameters to support decision on parenteral nutrition in palliative care

Front Nutr. 2023 Nov 3:10:1173106. doi: 10.3389/fnut.2023.1173106. eCollection 2023.

Authors

Lea Kum^#¹, Elisabeth L Zeilinger^#^{1

2

3}, Dagmar Vohla¹, Anna Kitta¹, Nadine Brunevskaya^{1

2}, Feroniki Adamidis¹, Franziska Ecker¹, Eva K Masel¹, Brigitte Mayr-Pirker⁴, Alexa L Meyer³, Bärbel Sturtzel³, Gudrun Kreye⁵, Matthias Unseld^{1

3}

Affiliations

¹ Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
² Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria.
³ Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria.
⁴ Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.
⁵ Division of Palliative Care, Department of Internal Medicine II, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria.

^# Contributed equally.

Abstract

Introduction: Parenteral nutrition (PN) is widely used in palliative care (PC), but there is limited evidence to support its use at the end of life (EOL). This aim of this was to investigate the relationship between routine laboratory parameters and survival in patients receiving PN, and to develop a decision tree model to support clinicians decide whether to start or forgo PN.

Methods: The laboratory parameters of 113 patients with advanced diseases who were admitted to a specialized palliative care unit (PCU) were analyzed at two points in time: T0 = before PN, T1 = two weeks after initiation of PN. Univariate Mann-Whitney U-tests and multivariate linear regression models, as well as a decision tree analysis were computed; all in relation to survival time.

Results: The final regression model was significant with p = 0.001 (adjusted R2 = 0.15) and included two predictors for survival time after PN initiation: the CRP/albumin ratio and urea at T1 (ps = 0.019). Decision tree analysis revealed three important predictors for classification of survival time after PN initiation: CRP, urea, and LDH (all at T0).

Discussion: The decision tree model may help to identify patients likely to benefit from PN, thus supporting the clinical decision whether or not to start PN.

Keywords: biomarkers; cachexia; cancer; decision tree; palliative care; parenteral nutrition; prognostic score; routine laboratory parameters.

Grants and funding

This research was partly funded by the “City of Vienna Fund for Innovative Interdisciplinary Cancer Research” provided by the Government of Vienna, Austria (Grant number: 21157). The APC was funded by University of Vienna.