Enteral nutrition support in patients with cancer: association of short-term prognosis and medical costs with inflammation.

IF 2.8 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES Supportive Care in Cancer Pub Date : 2024-12-22 DOI:10.1007/s00520-024-09085-y

Chenan Liu, Li Deng, Shiqi Lin, Tong Liu, Jiangshan Ren, Jinyu Shi, Heyang Zhang, Hailun Xie, Yue Chen, Xin Zheng, ZhaoTing Bu, Hanping Shi

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Abstract

Background: Enteral nutrition (EN) is commonly used for nutritional support in patients with cancer. Whether inflammation, one of the driving factors of malnutrition and cancer, affects the association between EN and short-term prognosis and medical costs in patients with cancer remains unclear. We aimed to investigate the association between EN and short-term prognosis of patients with cancer and the effect of inflammation on EN-associated medical costs.

Methods: This multicentre prospective cohort study evaluated patients with pathologically confirmed solid tumours. After admission, all patients who received EN, including oral or tube feeding, were assigned to the EN group. The log-rank test was used to identify the optimal cutoff values for inflammatory markers. Cox regression analysis was used to analyse the associations among EN, inflammation, and prognosis. Propensity score matching was used to balance biases between the EN and non-EN groups and validate the stability of the results.

Results: A total of 5121 patients were included, with 2965 (57.90%) men and an average age of 59.06 (11.30) years. A total of 462 patients received EN, with 390 (84.4%) receiving oral nutritional supplementation. During the 90-day follow-up, 304 patients died. In the low inflammation group, there was no association between EN and short-term prognosis (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.39-2.18). In the high inflammation group, EN significantly improved the short-term prognosis (HR = 0.48, 95% CI = 0.30-0.76). In patients with low inflammation (p < 0.001), EN increased hospitalisation costs (p < 0.001) without reducing length of stay (LOS) (p = 0.15). In patients with high inflammation, EN did not increase hospitalisation expenses (p = 0.47) but reduced the LOS (p = 0.004).

Conclusion: EN can improve the short-term prognosis of patients with high inflammation and reduce LOS without increasing the hospitalisation expenses. Baseline inflammation levels may serve as effective indicators for personalised and precise EN treatment.

Clinical trial registration: ChiCTR1800020329 (chictr.org.cn).

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癌症患者的肠内营养支持：短期预后和医疗费用与炎症的关系

背景：肠内营养（EN）是癌症患者常用的营养支持方法。炎症作为营养不良和癌症的驱动因素之一，是否影响EN与癌症患者短期预后和医疗费用之间的关系尚不清楚。我们的目的是研究EN与癌症患者短期预后的关系，以及炎症对EN相关医疗费用的影响。方法：这项多中心前瞻性队列研究评估了病理证实的实体瘤患者。入院后，所有接受EN（包括口服或管饲）的患者被分配到EN组。log-rank检验用于确定炎症标志物的最佳临界值。采用Cox回归分析EN、炎症和预后之间的关系。倾向评分匹配用于平衡EN组和非EN组之间的偏差，并验证结果的稳定性。结果：共纳入5121例患者，其中男性2965例（57.90%），平均年龄59.06（11.30）岁。共有462例患者接受EN治疗，其中390例（84.4%）接受口服营养补充。在90天的随访中，304名患者死亡。在低炎症组，EN与短期预后无相关性（风险比[HR] = 0.92, 95%可信区间[CI] = 0.39-2.18）。在高炎症组，EN显著改善短期预后（HR = 0.48, 95% CI = 0.30-0.76）。结论：EN可在不增加住院费用的情况下改善高炎症患者的短期预后，降低LOS。基线炎症水平可以作为个性化和精确治疗EN的有效指标。临床试验注册：ChiCTR1800020329 （chictr.org.cn）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Supportive Care in Cancer 医学-康复医学

CiteScore

5.70

自引率

9.70%

发文量

751

审稿时长

3 months

期刊介绍： Supportive Care in Cancer provides members of the Multinational Association of Supportive Care in Cancer (MASCC) and all other interested individuals, groups and institutions with the most recent scientific and social information on all aspects of supportive care in cancer patients. It covers primarily medical, technical and surgical topics concerning supportive therapy and care which may supplement or substitute basic cancer treatment at all stages of the disease. Nursing, rehabilitative, psychosocial and spiritual issues of support are also included.