J Clin Nutr.  2019 Jun;11(1):12-22. 10.15747/jcn.2019.11.1.12.

Nutritional Therapy Related Complications in Hospitalized Adult Patients: A Korean Multicenter Trial

Affiliations
  • 1Nutrition Support Team, Seoul National University Hospital, Seoul, Korea. appe98@snu.ac.kr
  • 2Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
  • 3Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
  • 4Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 5Department of Surgery, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea.
  • 6Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
  • 7Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 8Department of General Surgery, The Catholic University of Korea, St. Paul's Hospital, Seoul, Korea.
  • 9Department of Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
  • 10Division of Gastroenterology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 11Department of Surgery, Yeungnam University Medical Center, Daegu, Korea.
  • 12Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea.
  • 13Department of Surgery, Chungnam National University Hospital, Daejeon, Korea.
  • 14Department of Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Korea.
  • 15Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 16Department of Surgery, Hanyang University College of Medicine, Seoul, Korea.
  • 17Department of Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 18Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea.
  • 19Department of Trauma Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
  • 20Department of Surgery, Samsung Medical Center, Seoul, Korea.
  • 21Division of Acute Care Surgery, Department of Surgery, Ajou University Hospital, Suwon, Korea.
  • 22Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
  • 23Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 24Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
  • 25Department of Surgery, National Cancer Center, Goyang, Korea.
  • 26Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 27Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 28Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
  • 29Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking.
METHODS
Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients' demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected.
RESULTS
A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m2. The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; "micronutrient and vitamin deficiency" (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay.
CONCLUSION
NT may induce or be associated with several complications, and some of them may seriously affect the patient's outcome. NST personnel in each hospital should be aware of each problem during nutritional support.

Keyword

Nutrition therapy; Parenteral nutrition; Enteral nutrition; Complications; Multicenter study

MeSH Terms

Adult*
Body Mass Index
Demography
Diarrhea
Enteral Nutrition
Hospitalization
Humans
Hyperammonemia
Intensive Care Units
Korea
Length of Stay
Multicenter Studies as Topic*
Nutrition Therapy
Nutritional Support
Parenteral Nutrition
Referral and Consultation
Retrospective Studies
Vitamins
Vitamins
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