Impact of multichamber bag parenteral nutrition (OliClinomel) upon inflammatory markers (EPICOS Study)

Introduction

The use of a multichamber bag (MCB) as a way to deliver parenteral nutrition to critically ill patients has been associated by retrospective analysis with several benefits including lower bloodstream infection rates, and lower ICU stay [1]. This study aims to evaluate the effects of a MCT TPN system (considered a closed system) versus a conventional compounding system (COM, considered an open system) regardless of the type of lipid emulsion used.

Methods

Serum samples were collected in a prospective multicenter open label study (NCT#00798681) from 100 critical care patients receiving TPN with an olive oil-based lipid emulsion using either a premixed MCB and ready-to-use system (n = 50, OliClinomel; Baxter) or COM made either with an olive oil-based lipid emulsion (ClinOleic; Baxter) or with a LCT/MCT-based lipid emulsion (COM ClinOleic n = 25, COM LCT/MCT n = 25, total COM group n = 50). All samples were collected at baseline, day 4 and day 7 (three samples per time point). Changes in the levels of inflammatory markers from baseline to day 7 were compared using analysis of covariance and P < 0.05 was considered statistically significant.

Results

At baseline, demographic characteristics of the patients were balanced between the groups. Regardless of the type of lipid used, critically ill patients receiving TPN using a MCB system presented at day 4 lower levels of: TNFα (3.4 vs 8.2 pg/ml), IL-6 (50.4 vs 62.0 pg/ml), IL-8 (56.4 vs 93.7 pg/ml), procalcitonin (PCT) (2.7 vs 7.6 ng/ml), lymphocyte externalization of phosphatidylserine (5.2 vs 9.6%), and resistin (9.1 vs 12.3 ng/ml) (all MCB vs COM and P < 0.05). Statistically significant differences were maintained throughout day 7. No differences were observed for the levels of C-reactive protein and IL-10.

Conclusions

The administration of TPN using a MCB system led to a significant reduction in the inflammatory response when compared with COM, regardless of the type of lipid used. Particularly relevant are the differences in terms of PCT as an early marker of sepsis since COM TPN was associated in previous studies with higher bloodstream infection rates [1].