RESUMEN
BACKGROUND AND AIMS: To investigate the incidence and the severity of COVID-19 infection in patients enrolled in the database for home parenteral nutrition (HPN) for chronic intestinal failure (CIF) of the European Society for Clinical Nutrition and Metabolism (ESPEN). METHODS: Period of observation: March 1st, 2020 March 1st, 2021. INCLUSION CRITERIA: patients included in the database since 2015 and still receiving HPN on March 1st, 2020 as well as new patients included in the database during the period of observation. Data related to the previous 12 months and recorded on March 1st 2021: 1) occurrence of COVID-19 infection since the beginning of the pandemic (yes, no, unknown); 2) infection severity (asymptomatic; mild, no-hospitalization; moderate, hospitalization no-ICU; severe, hospitalization in ICU); 3) vaccinated against COVID-19 (yes, no, unknown); 4) patient outcome on March 1st 2021: still on HPN, weaned off HPN, deceased, lost to follow up. RESULTS: Sixty-eight centres from 23 countries included 4680 patients. Data on COVID-19 were available for 55.1% of patients. The cumulative incidence of infection was 9.6% in the total group and ranged from 0% to 21.9% in the cohorts of individual countries. Infection severity was reported as: asymptomatic 26.7%, mild 32.0%, moderate 36.0%, severe 5.3%. Vaccination status was unknown in 62.0% of patients, non-vaccinated 25.2%, vaccinated 12.8%. Patient outcome was reported as: still on HPN 78.6%, weaned off HPN 10.6%, deceased 9.7%, lost to follow up 1.1%. A higher incidence of infection (p = 0.04), greater severity of infection (p < 0.001) and a lower vaccination percentage (p = 0.01) were observed in deceased patients. In COVID-19 infected patients, deaths due to infection accounted for 42.8% of total deaths. CONCLUSIONS: In patients on HPN for CIF, the incidence of COVID-19 infection differed greatly among countries. Although the majority of cases were reported to be asymptomatic or have mild symptoms only, COVID-19 was reported to be fatal in a significant proportion of infected patients. Lack of vaccination was associated with a higher risk of death.
Asunto(s)
COVID-19 , Enfermedades Intestinales , Insuficiencia Intestinal , Nutrición Parenteral en el Domicilio , Humanos , COVID-19/epidemiología , Enfermedades Intestinales/epidemiología , Enfermedades Intestinales/terapia , Nutrición Parenteral en el Domicilio/efectos adversosRESUMEN
Background and aims To investigate the incidence and the severity of COVID-19 infection in patients enrolled in the database for home parenteral nutrition (HPN) for chronic intestinal failure (CIF) of the European Society for Clinical Nutrition and Metabolism (ESPEN). Methods Period of observation: March 1st, 2020 March 1st, 2021. Inclusion criteria: patients included in the database since 2015 and still receiving HPN on March 1st, 2020 as well as new patients included in the database during the period of observation. Data related to the previous 12 months and recorded on March 1st 2021: 1) occurrence of COVID-19 infection since the beginning of the pandemic (yes, no, unknown);2) infection severity (asymptomatic;mild, no-hospitalization;moderate, hospitalization no-ICU;severe, hospitalization in ICU);3) vaccinated against COVID-19 (yes, no, unknown);4) patient outcome on March 1st 2021: still on HPN, weaned off HPN, deceased, lost to follow up. Results Sixty-eight centres from 23 countries included 4,680 patients. Data on COVID-19 were available for 55.1% of patients. The cumulative incidence of infection was 9.6% in the total group and ranged from 0% to 21.9% in the cohorts of individual countries. Infection severity was reported as: asymptomatic 26.7%, mild 32.0%, moderate 36.0%, severe 5.3%. Vaccination status was unknown in 62.0% of patients, non-vaccinated 25.2%, vaccinated 12.8%. Patient outcome was reported as: still on HPN 78.6%, weaned off HPN 10.6%, deceased 9.7%, lost to follow up 1.1%. A higher incidence of infection (p=0.04), greater severity of infection (p<0.001) and a lower vaccination percentage (p=0.01) were observed in deceased patients. In COVID-19 infected patients, deaths due to infection accounted for 42.8% of total deaths. Conclusions In patients on HPN for CIF, the incidence of COVID-19 infection differed greatly among countries. Although the majority of cases were reported to be asymptomatic or have mild symptoms only, COVID-19 was reported to be fatal in a significant proportion of infected patients. Lack of vaccination was associated with a higher risk of death.
RESUMEN
Résumé La nutrition artificielle à domicile, entérale ou parentérale, s’adresse à des malades chroniques fragiles. La situation actuelle de pandémie COVID-19 peut compromettre leur prise en charge à plusieurs niveaux : difficultés d’accès aux établissements de santé largement réorientés vers la prise en charge des malades COVID-19, possible pénurie d’infirmières à domicile, forte réduction des visites des prestataires de service à domicile, tensions sur les solutions hydro-alcooliques, les masques et les régulateurs de débit. Le but de ces recommandations établies par le Comité de Nutrition à Domicile de la Société Francophone de Nutrition Clinique et Métabolisme est, d’une part, de préciser la prise en charge minimale de ces patients, tant en termes de suivi que de matériels, mais surtout de s’adapter aux tensions actuelles relatives aux personnes et aux matériels, afin de poursuivre une prise en charge de qualité et de ne pas compromettre l’état de santé des patients en nutrition artificielle à domicile pendant la crise. Home artificial nutrition, whether enteral or parenteral, is provided to chronic and fragile patients. The current COVID-19 epidemics may compromise their care at several levels: difficulties to access to hospitals mainly focused on treating COVID-19 patients, possible lack of nurses at home, strong reduction of visits by homecare providers, tended flow or lack of hand sanitizers, surgical masks and pumps. The aim of these recommendations put together by the French-speaking Society for Clinical Nutrition and Metabolism (SFNCM)’s Home Artificial Nutrition Committee is to define in terms of healthcare resources the minimum care to provide to these patients. We also aim to help cope with the possible tensions, in order to secure the care we must provide to home artificial nutrition patients during this crisis.