Hospitalization rates among patients with cystic fibrosis using pancreatic enzyme replacement therapy

Abstract

We investigated the relationship between self-reported adherence to pancreatic enzyme replacement therapy (PERT), nutritional status, and all-cause hospitalization in cystic fibrosis (CF) patients with a record of PERT use. Association of self-reported annual PERT use rate (adherence) with annual hospital admission rate (HAR) and annual total hospital nights (THNs) were analyzed for 5301 children (2000–2012) and 13,989 adults (2000–2013) from the CF Foundation Patient Registry. Multivariate linear regression was used to determine the association of HAR and THN with mean annual PERT use rate, cumulative PERT use rate, mean body mass index (BMI) (adult) or BMI percentile (pediatric), age, and sex. The median annual PERT use rate was 87% in children and 80% in adults. Statistically, higher annual PERT use, longer cumulative PERT, and higher BMI percentile (children) or BMI (adults) were significantly ( p < 0.0001) associated with lower annual HAR and fewer annual THN in children and adults. Female sex was associated with higher annual HAR and more annual THN in children and adults ( p < 0.05). Results indicate self-reported adherence to PERT, increased BMI, and male sex were associated with fewer hospital admissions and annual hospital nights in CF patients.

Intestinal Absorption of Lipids Using a Pancreatic Enzyme-Free Nutritional Supplement in Patients with Cystic Fibrosis: A Randomized, Double-Blind, Crossover Pilot Trial

“…Adherence with PERT remains a significant issue for patients with CF diagnosed with EPI [ 11 , 12 ]. A recent study reported that adherence to PERT is independently associated with a reduction in hospitalization and length of stay for both children and adults with CF, and it suggested that strategies which improve PERT adherence would improve outcomes in this patient population [ 13 ]. The above highlights the potential benefits of a PERT-free alternative like EMO-ONS for patients with CF diagnosed with EPI.…”

“…Since PERT often requires patients to take 10 to 15 enzyme capsules per day, compliance can be problematic, with an overall adherence rate for taking pancreatic enzymes reported at less than 50% [ 11 , 12 ]. As a result, identifying a PERT-free alternative to nutritional supplementation for patients with cystic fibrosis can potentially lead to improved nutritional status and a reduction in the risk of hospitalizations associated with non-adherence to PERT [ 13 ].…”

Current and Future Therapeutic Approaches of Exocrine Pancreatic Insufficiency in Children with Cystic Fibrosis in the Era of Personalized Medicine

“…A study conducted by Trapnell et al, demonstrated a correlation between adherence to PERT and increased body mass index (BMI) with a decrease in hospitalization rate, strengthening the observation that there is a close association between nutritional status and clinical outcomes. It is well known that in children with CF, reduced lung function is associated with an increased rate of hospitalization, and poor nutritional status, whereas a better nutritional status has a positive impact on lung function and survival rate [ 38 , 73 , 74 ].…”

Individualized pharmaceutical care for a patient after pancreaticoduodenectomy with trypsin replacement nutritional therapy: A case report

“…However, PD cases of pancreatin deficiency, vitamin and mineral deficiency, steatorrhea, weight loss, and nutrient deficiency have been reported. [1] Therefore, it is important to pay close attention to the nutritional status of patients with PD and correct malnutrition reasonably. Patients often report elevations in tablet platoon and steatorrhea, and steatorrhea may adversely affect nutritional therapy for PD.…”