TY - JOUR
T1 - Dose-Dependent Effects of Amino Acids on Clinical Outcomes in Adult Medical Inpatients Receiving Only Parenteral Nutrition
T2 - A Retrospective Cohort Study Using a Japanese Medical Claims Database
AU - Takagi, Kosei
AU - Murotani, Kenta
AU - Kamoshita, Satoru
AU - Kuroda, Akiyoshi
N1 - Funding Information:
This research was funded by Otsuka Pharmaceutical Factory, Inc.
Publisher Copyright:
© 2022 by the authors.
PY - 2022/9
Y1 - 2022/9
N2 - The majority of inpatients requiring parenteral nutrition (PN) do not receive adequate amino acid, which may negatively impact clinical outcomes. We investigated the influence of amino acid doses on clinical outcomes in medical adult inpatients fasting >10 days and receiving only PN, using Japanese medical claims database. The primary endpoint was in-hospital mortality, and the secondary endpoints included deterioration of activities of daily living (ADL), intravenous catheter infection, hospital readmission, hospital length of stay (LOS), and total medical costs. Patients were divided into four groups according to their mean prescribed daily amino acid doses from Days 4 to 10 of fasting: Adequate (≥0.8 g/kg/day), Moderate (≥0.6–<0.8 g/kg/day), Low (≥0.4–<0.6 g/kg/day), and Very low (<0.4 g/kg/day). Multivariate logistic or multiple regression analyses were performed with adjustments for patient characteristics (total n = 86,702). The Adequate group was used as the reference in all analyses. For the Moderate, Low, and Very low groups, adjusted ORs (95% CI) of in-hospital mortality were 1.20 (1.14–1.26), 1.43 (1.36–1.51), and 1.72 (1.62–1.82), respectively, and for deterioration of ADL were 1.21 (1.11–1.32), 1.34 (1.22–1.47), and 1.22 (1.09–1.37), respectively. Adjusted regression coefficients (95% CI) of hospital LOS were 1.2 (0.4–2.1), 1.5 (0.6–2.4), and 2.9 (1.8–4.1), respectively. Lower prescribed doses of amino acids were associated with worse clinical outcomes including higher in-hospital mortality.
AB - The majority of inpatients requiring parenteral nutrition (PN) do not receive adequate amino acid, which may negatively impact clinical outcomes. We investigated the influence of amino acid doses on clinical outcomes in medical adult inpatients fasting >10 days and receiving only PN, using Japanese medical claims database. The primary endpoint was in-hospital mortality, and the secondary endpoints included deterioration of activities of daily living (ADL), intravenous catheter infection, hospital readmission, hospital length of stay (LOS), and total medical costs. Patients were divided into four groups according to their mean prescribed daily amino acid doses from Days 4 to 10 of fasting: Adequate (≥0.8 g/kg/day), Moderate (≥0.6–<0.8 g/kg/day), Low (≥0.4–<0.6 g/kg/day), and Very low (<0.4 g/kg/day). Multivariate logistic or multiple regression analyses were performed with adjustments for patient characteristics (total n = 86,702). The Adequate group was used as the reference in all analyses. For the Moderate, Low, and Very low groups, adjusted ORs (95% CI) of in-hospital mortality were 1.20 (1.14–1.26), 1.43 (1.36–1.51), and 1.72 (1.62–1.82), respectively, and for deterioration of ADL were 1.21 (1.11–1.32), 1.34 (1.22–1.47), and 1.22 (1.09–1.37), respectively. Adjusted regression coefficients (95% CI) of hospital LOS were 1.2 (0.4–2.1), 1.5 (0.6–2.4), and 2.9 (1.8–4.1), respectively. Lower prescribed doses of amino acids were associated with worse clinical outcomes including higher in-hospital mortality.
KW - amino acids
KW - clinical outcomes
KW - medical inpatient
KW - parenteral nutrition
KW - real-world data
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U2 - 10.3390/nu14173541
DO - 10.3390/nu14173541
M3 - Article
C2 - 36079799
AN - SCOPUS:85137610492
SN - 2072-6643
VL - 14
JO - Nutrients
JF - Nutrients
IS - 17
M1 - 3541
ER -