Uwumiro Fidelis, Olaomi Oluwatobi A, Tobalesi Opeyemi, Okpujie Victory, Abesin Olawale, Ekata Enomen, Ezerioha Pascal, Umoudoh Uwakmfonabasi A, Olapade Zainab, Asobara Evaristus
Internal Medicine, Our Lady of Apostles Hospital, Akwanga, NGA.
Radiology, University of Ibadan, Ibadan, NGA.
Cureus. 2023 Sep 9;15(9):e44957. doi: 10.7759/cureus.44957. eCollection 2023 Sep.
Despite considerable research on the comparison of enteral and parenteral nutrition in patients with acute pancreatitis, there is an ongoing debate about the optimal timing of nutrition initiation, invasiveness of interventions, impact on outcomes, and patient tolerance. Given the gap that still exists in the literature, we investigated the relationship between the mode of nutrition and critical outcomes such as mortality rates, inpatient complications, length of hospitalization, and discharge disposition, using comprehensive national-level data. In addition, we investigated the impact of early enteral nutrition on outcomes in acute pancreatitis.
All adult discharges for acute pancreatitis between 2016 and 2018 were analyzed from the National (Nationwide) Inpatient Sample (NIS). Discharges of minors and those involving mixed nutrition were excluded from the analysis. Enteral nutrition and parenteral nutrition subgroups were identified using the International Classification of Diseases, 10th revision (ICD-10) codes. Disease severity was defined using the 2013 revised Atlanta Classification of Acute Pancreatitis, along with the All Patient Refined Diagnosis Related Group (APR-DRG)'s severity of illness and likelihood of mortality variables. Complications were identified using ICD-10 codes from the secondary diagnoses variables within the NIS dataset. Multivariable logistic regression analyses were employed to assess associations between the mode of nutrition and the outcomes of interest.
A total of 379,410 hospitalizations were studied. About 2,011 (0.53%) received enteral nutrition, while 4,174 (1.1%) received parenteral nutrition. The mean age of the study was 51.7 years (SD 0.1). About 2,280 mortalities were recorded in the study. After adjustments, enteral nutrition was associated with significantly lower odds of mortality (adjusted OR (aOR): 0.833; 95%CI: 0.497-0.933; P<0.001). Parenteral nutrition was linked with significantly greater odds of mortality (aOR: 6.957; 95%CI: 4.730-10.233; P<0.001). Both enteral nutrition and parenteral nutrition were associated with augmented odds of complications and prolonged hospitalization (P<0.001) compared to normal oral feeding. Initiation of enteral nutrition within 24 hours of admission did not improve the odds of mortality in this study (aOR: 5.619; 95%CI: 1.900-16.615; P=0.002).
Enteral nutrition demonstrates better outcomes in mortality rates and systemic complications compared to parenteral nutrition in patients unable to maintain normal oral feeding.
尽管对急性胰腺炎患者肠内营养和肠外营养的比较进行了大量研究，但关于营养起始的最佳时机、干预的侵入性、对结局的影响以及患者耐受性仍存在争议。鉴于文献中仍然存在的差距，我们使用全面的国家级数据研究了营养模式与死亡率、住院并发症、住院时间和出院处置等关键结局之间的关系。此外，我们还研究了早期肠内营养对急性胰腺炎结局的影响。
对2016年至2018年全国住院患者样本（NIS）中所有急性胰腺炎成人出院病例进行分析。分析排除了未成年人出院病例和涉及混合营养的病例。使用国际疾病分类第10版（ICD-10）编码确定肠内营养和肠外营养亚组。根据2013年修订的亚特兰大急性胰腺炎分类以及所有患者精细诊断相关组（APR-DRG）的疾病严重程度和死亡可能性变量来定义疾病严重程度。使用NIS数据集中二级诊断变量的ICD-10编码确定并发症。采用多变量逻辑回归分析来评估营养模式与感兴趣的结局之间的关联。
共研究了379,410例住院病例。约2,011例（0.53%）接受了肠内营养，而4,174例（1.1%）接受了肠外营养。研究对象的平均年龄为51.7岁（标准差0.1）。研究中记录了约2,280例死亡病例。调整后，肠内营养与显著较低的死亡几率相关（调整后的比值比（aOR）：0.833；95%置信区间：0.497-0.933；P<0.001）。肠外营养与显著较高的死亡几率相关（aOR：6.957；95%置信区间：4.730-10.233；P<0.001）。与正常经口喂养相比，肠内营养和肠外营养均与并发症几率增加和住院时间延长相关（P<0.001）。在本研究中，入院后24小时内开始肠内营养并未改善死亡几率（aOR：5.619；95%置信区间：1.900-16.615；P=0.002）。
对于无法维持正常经口喂养的患者，与肠外营养相比，肠内营养在死亡率和全身并发症方面显示出更好的结局。
