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Observational Study
. 2024 May 22;16(11):1569.
doi: 10.3390/nu16111569.

Nutritional Status as a Prognostic Factor for Survival in Palliative Care: A Retrospective Observational Analysis of Home Parenteral Nutrition in Cancer Patients with Inoperable Malignant Bowel Obstruction

Karolina Tenderenda  1 , Aleksandra Gierczak  1 , Mariusz Panczyk  2 , Jacek Sobocki  3 , Zuzanna Zaczek  3   4
Affiliations
Observational Study

Nutritional Status as a Prognostic Factor for Survival in Palliative Care: A Retrospective Observational Analysis of Home Parenteral Nutrition in Cancer Patients with Inoperable Malignant Bowel Obstruction

Karolina Tenderenda et al. Nutrients. .

Abstract

Palliative care patients with malignant bowel obstruction are particularly at risk of developing malnutrition, which in turn directly shortens survival time and worsens quality of life (QoL). According to the available data, the survival time in this patient group is often less than three months. To avoid further complications related to malnutrition and poor outcomes in oncological therapy, nutritional therapy such as home parenteral nutrition (HPN) is offered. The aim of this study was to investigate whether nutritional status is a prognostic factor for survival in palliative care patients with malignant inoperable bowel obstruction qualified for home parenteral nutrition and which nutritional assessment tool has the most accurate prognostic value. This retrospective observational analysis included 200 patients with malignant bowel obstruction referred for home parenteral nutrition between January 2018 and August 2023. The analysis included laboratory test results, body mass index (BMI), Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI) and malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM). The average survival time of the patients was 75 days. Patients with higher NRI and PNI scores were more likely to survive (NRI: p < 0.001; PNI: p < 0.001). The GLIM criteria, SGA scores and BMI values did not prove to be good prognostic factors for survival (GLIM p = 0.922, SGA p = 0.083, BMI p = 0.092). The results suggest that the use of NRI and PNI may be helpful in prognosing survival in these patients and that prevention of the development of malnutrition through earlier nutritional assessment and intervention should be considered in this patient group.

Keywords: home parenteral nutrition; malignant inoperable bowel obstruction; malnutrition; palliative care patients; survival time.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart: patients who met the inclusion criteria and qualified for the study group.
Figure 2
Figure 2
Kaplan–Meier curve for overall survival in palliative oncological patients with malignant bowel obstruction.
Figure 3
Figure 3
Probability of survival in palliative oncological patients with malignant bowel obstruction considering Prognostic Nutritional Index (PNI).
Figure 4
Figure 4
Probability of survival in palliative oncological patients with malignant bowel obstruction including NRI (A) and GNRI (B).
Figure 5
Figure 5
Probability of survival in palliative oncological patients with malignant bowel obstruction depending on GLIM (A), SGA (B) and BMI (C).
Figure 6
Figure 6
Receiver Operating Characteristic (ROC) curve for PNI (A) and NRI (B) scoring.
See this image and copyright information in PMC

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