Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Cell Infect Microbiol. 2022 Jul 22;12:938581. doi: 10.3389/fcimb.2022.938581. eCollection 2022.
The optimal timing of enteral nutrition (EN) initiation in predicted severe acute gallstone pancreatitis (SAGP) and its influence on disease outcomes are not well known.
We conducted a retrospective study of patients with predicted SAGP treated with endoscopic retrograde cholangiopancreatography and EN. The patients were classified into two groups according to the timing of EN initiation after admission: within 48 h, and more than 48 h. The primary outcome was in-hospital mortality. The secondary outcomes were length of hospital stay, need for intensive care admission, need for surgical intervention, improvements in blood test results after 7-10 days of EN, incidence of pancreatic necrosis and infection, and hospital care costs. The microbiological profiles of infectious complications were also evaluated.
Of the 98 patients, 31 and 67 started EN within 48 h, and more than 48 h after admission, respectively. Early EN was associated with a decrease in in-hospital mortality (0 vs. 11.9%; p=0.045), length of hospital stay (median:18 . 27 days; p=0.001), need for intensive care admission (3.2% . 20.9%; p=0.032), and hospital care costs (median:9,289 . 13,518 US$; p=0.007), compared to delayed EN. Moreover, early EN for 7-10 days had more beneficial effects on blood test results than delayed EN, including total protein (p=0.03) and CRP (p=0.006) levels. However, the need for surgical intervention and incidence of pancreatic necrosis did not differ between the two groups. In our study, Gram-negative bacteria were the main responsible pathogens (50.5%). Infection with multidrug-resistant organisms (MDRO) was found in 19.4% of the patients. The most common MDRO was MDR . Early EN was not superior in reducing incidence of infected pancreatic necrosis, bacteremia, polymicrobial infection, or MDROs.
In patients with predicted SAGP, early EN is associated with a decrease in in-hospital mortality, length of hospital stay, need of intensive care admission, and hospital care costs, compared to delayed EN. There are no significant benefits of early EN in reducing the rate of infection-related complications. Further studies with larger sample sizes are warranted.
在预测性重症急性胆源性胰腺炎（SAGP）中，肠内营养（EN）开始的最佳时机及其对疾病结局的影响尚不清楚。
我们对接受内镜逆行胰胆管造影术和 EN 治疗的预测性 SAGP 患者进行了回顾性研究。根据入院后 EN 开始的时间，患者分为两组：48 小时内和 48 小时以上。主要结局是住院死亡率。次要结局包括住院时间、需要重症监护病房入院、需要手术干预、EN 后 7-10 天血液检查结果改善、胰腺坏死和感染的发生率以及住院治疗费用。还评估了感染性并发症的微生物谱。
在 98 例患者中，31 例和 67 例分别在入院后 48 小时内和 48 小时以上开始 EN。早期 EN 与住院死亡率降低相关（0 比 11.9%；p=0.045）、住院时间缩短（中位数：18.27 天；p=0.001）、需要重症监护病房入院（3.2% 比 20.9%；p=0.032）和住院治疗费用降低（中位数：9289 比 13518 美元；p=0.007），与延迟 EN 相比。此外，与延迟 EN 相比，早期 EN 持续 7-10 天对血液检查结果的改善效果更好，包括总蛋白（p=0.03）和 CRP（p=0.006）水平。然而，两组之间手术干预的需求和胰腺坏死的发生率没有差异。在我们的研究中，革兰氏阴性菌是主要的致病病原体（50.5%）。发现 19.4%的患者感染了多药耐药菌（MDRO）。最常见的 MDRO 是耐多药革兰氏阴性菌。早期 EN 并不能降低感染性胰腺坏死、菌血症、混合感染或 MDRO 的发生率。
与延迟 EN 相比，在预测性 SAGP 患者中，早期 EN 与住院死亡率、住院时间、需要重症监护病房入院和住院治疗费用降低相关。早期 EN 并没有降低与感染相关并发症的发生率。需要进一步进行更大样本量的研究。
