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. 2023 Jun:55:212-220.
doi: 10.1016/j.clnesp.2023.03.008. Epub 2023 Mar 30.

COVID-19 infection in patients on long-term home parenteral nutrition for chronic intestinal failure

Loris Pironi  1 , Denise Jezerski  2 , Jacek Sobocki  3 , Simon Lal  4 , Tim Vanuytsel  5 , Miriam Theilla  6 , Anna S Sasdelli  7 , Cecile Chambrier  8 , Konrad Matysiak  9 , Umberto Aimasso  10 , Henrik H Rasmussen  11 , Amelia Jukes  12 , Marek Kunecki  13 , David Seguy  14 , Stéphane M Schneider  15 , Joanne Daniels  16 , Florian Poullenot  17 , Manpreet S Mundi  18 , Przemysław Matras  19 , Marcin Folwarski  20 , Adriana Crivelli  21 , Nicola Wyer  22 , Lars Ellegard  23 , Lidia Santarpia  24 , Marianna Arvanitakis  25 , Corrado Spaggiari  26 , Georg Lamprecht  27 , Francesco W Guglielmi  28 , Antonella Lezo  29 , Sabrina Layec  30 , Esther Ramos Boluda  31 , Anat Guz-Mark  32 , Paolo Gandullia  33 , Cristina Cuerda  34 , Emma Osland  35 , Maria I Spagnuolo  36 , Zeljko Krznaric  37 , Luisa Masconale  38 , Brooke Chapman  39 , María Maíz-Jiménez  40 , Paolo Orlandoni  41 , Mariana Hollanda Martins da Rocha  42 , M Nuria Virgili-Casas  43 , Maryana Doitchinova-Simeonova  44 , Laszlo Czako  45 , Andrè Van Gossum  46 , Lorenzo D'Antiga  47 , Looi C Ee  48 , Daruneewan Warodomwichit  49 , Marina Taus  50 , Sanja Kolaček  51 , Ronan Thibault  52 , Giovanna Verlato  53 , Aurora E Serralde-Zúñiga  54 , José I Botella-Carretero  55 , Pilar Serrano Aguayo  56 , Gabriel Olveira  57 , Sirinuch Chomtho  58 , Veeradej Pisprasert  59 , Georgijs Moisejevs  60 , Ana Zugasti Murillo  61 , Ma Estrella Petrina Jáuregui  62 , Marta Bueno Díez  63 , Mohammad Shukri Jahit  64 , Narumon Densupsoontorn  65 , Ali Tamer  66 , Giorgia Brillanti  67 , Francisca Joly  68
Affiliations

COVID-19 infection in patients on long-term home parenteral nutrition for chronic intestinal failure

Loris Pironi et al. Clin Nutr ESPEN. 2023 Jun.

Abstract

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.

Keywords: COVID-19; Epidemiology; Home parenteral nutrition; Intestinal failure; Pandemic; SARS-CoV-2.

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Conflict of interest statement

Conflict of interest statements LP: Participation on a Data Safety Monitoring Board or Advisory Board for Takeda, Consulting fees for Takeda, Northsea, NAPO. SL: Participation on a Data Safety Monitoring Board or Advisory Board for Baxter, Takeda, NorthSea, VectivBio; Grants or contracts from any entity for Baxter, Takeda; Consulting fees for VectivBio, Takeda, Northsea; Support for attending meetings and/or travel for Takeda; Payment or honoraria for lectures for Takeda, Fresenius. PG: none. LS: none. PO: none. NW: none. RT: Royalties or licenses for Royalties for designing the Simple Evaluation of Food Intake® (SEFI®) (Knoë, le Kremlin Bicêtre, France); Consulting fees for Nestlé Health Science; Payment or honoraria for lectures for Baxter, BBraun, Fresenius-Kabi, Nutricia; Support for attending meetings for Nutricia, NHC. PS: none. LE: none. PO: none. L D’A: none. AT: none. ND: Leadership of Pediatric Nutrition Association of Thailand Society of Parenteral Enteral Nutrition of Thailand. ASZ: Payment or honoraria for lectures for Siegfried; Consulting for Takeda; Support for attending meetings for Abbott and Nestlè. MF: Payment or honoraria for lectures for Fresenius Kabi, B Braun, Baxter. GV: none. MIS: none. MT: none. ERB: none. NVC: Payment or honoraria for lectures for Takeda, Nutricia; Payment for expert testimony, Support for attending meetings and Participation on a Data Safety Monitoring Board for Takeda. AL: Consulting fees, Support for attending meetings, Participation on a Data Safety Monitoring Board or Advisory Board for Nestlè; Participation on a Data Safety Monitoring Board or Advisory Board for Takeda; Payment or honoraria for lectures for baxter. LC: none. MA: none. EO: none. AGM: none. AVG: none. VP: honoraria for lectures for Thai Otsuka Pharmaceutical Co., Ltd., Abbott Laboratories Ltd., Nestle (Thai) Ltd., Fresenius Medical Care (Thailand) Ltd., Baxter Healthcare (Thailand) Co., Ltd., Mega Lifesciences PTY Ltd., Novo Nordisk Thailand. MSM: Grants or contracts from any entity for Fresenius Kabi, Nestle, Realfood Blends, VectivBio, Rockfield, Zealand; Consulting fees, Northsea; Participation on a Data Safety Monitoring Board for EndoBarrier. M D-S: none. TV: Grants or contracts from any entity for Vectiv Bio, Takeda; Consulting fees for Vectiv Bio, Zealand Pharma, Takeda, Baxter, Hamni, NorthSea Therapeutics; Payment or honoraria for lectures for Vectiv Bio, Takeda, Baxter; Support for attending meetings for Takeda, Vectiv Bio, Zealand Pharma, Fresenius Kabi; Receipt of equipment, materials, drugs for VectivBio. ZK: Support for attending meetings for Abbott, Fresenius, Nutricia, Nestle, Takeda; Leadership for Croatian Medical Association- The President. FP: none. LM: none. LCE: Consulting fees, Payment or honoraria for lecture and Support for attending meetings for Takeda. UA: Payment or honoraria for lectures for Takeda, Baxter; Support for attending meetings and Participation on a Data Safety Monitoring for Takeda. MK: none. MMJ: none. AC: none. DW: none. GO: none. CC: none. JS: Grants or contracts from any entity and for BBraun, FreseniusKabi, Nestle; Payment or honoraria for lectures for BBraun, OlimpLabs, FreseniusKabi, Baxter, Nestle; Support for attending meetings for FreseniusKabi. FWG: none. CS: none. MBD: none. DS: none. SL: none. SK: Payment or honoraria for lectures, for Abbott, Abela Farm, Danone/Nutricia, Fresenius, GM Pharma, Nestle, Nestle Nutrition Institute, Oktal Pharma, Shire/Takeda; Non-restricted grant delivered to the hospital from BioGaia. BC: none. GM: none. MHMdC: Grants or contracts, Consulting fees, Payment or honoraria, Support for attending meetings, Participation on a Data Safety Monitoring for lectures for Takeda Pharmaceutical Brazil. EPJ: none. FJ: none. DJ: none. GL: none. AZM: none. MT: none. DZ: none. MK: Payment or honoraria for manuscript writing and educational events for Nutricia, FreseniusKabi. ASS: none. GB: none.

Figures

Fig. 1
Fig. 1
Annual cumulative incidence of COVID-19 infection in the total cohort of 2503 patients on home parenteral nutrition for chronic intestinal failure and in the cohorts of countries that included in the study at least 10 patients with known infection status.
Fig. 2
Fig. 2
Percentages of clinical severity of COVID-19 infection in 172 patients on home parenteral nutrition for chronic intestinal failure. Mild, no-hospitalization; Moderate, with hospitalization not in intensive care unit; Severe, hospitalization in intensive care unit.
Fig. 3
Fig. 3
Cumulative cases of COVID-19 infection in patients on home parenteral nutrition (HPN), from March 1st, 2020 to March 1st, 2021 and cumulative cases per 100 thousand population from the beginning of the pandemic (January 2020) to February 28th, 2021, as reported by the World Health Organization (WHO), in the individual countries.
See this image and copyright information in PMC

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