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Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis.

Li JY, Yu T, Chen GC, Yuan YH, Zhong W, Zhao LN, Chen QK - PLoS ONE (2013)

Bottom Line: Eleven studies containing 775 patients with acute pancreatitis were analyzed.Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21-0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11-0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31-0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11-0.52, P<0.05), in the length of hospitalization (mean difference -2.18; 95%CI -3.48-(-0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14-0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05).The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT

Background: Enteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial. The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages.

Methods and findings: We searched PubMed, EMBASE Databases, Web of Science, the Cochrane library, and scholar.google.com for all the relevant articles about the effect of enteral nutrition initiated within 48 hours of admission on the clinical outcomes of acute pancreatitis from inception to December 2012. Eleven studies containing 775 patients with acute pancreatitis were analyzed. Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21-0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11-0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31-0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11-0.52, P<0.05), in the length of hospitalization (mean difference -2.18; 95%CI -3.48-(-0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14-0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05). The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05).

Conclusion: Enteral nutrition within 48 hours of admission is feasible and improves the clinical outcomes in acute pancreatitis as well as in predicted severe or severe acute pancreatitis by reducing complications.

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Effect of early EN on all the infection complications of AP as a whole.(A) Forest plot (Random-effect model) showing the effect of early EN on all the infection complications of AP as a whole and the sensitivity analysis subtotaling the plots by RCTs vs. retrospective studies. (B) Forest plot (Random-effect model) of the stratified study conducted based on the severity of AP.
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pone-0064926-g002: Effect of early EN on all the infection complications of AP as a whole.(A) Forest plot (Random-effect model) showing the effect of early EN on all the infection complications of AP as a whole and the sensitivity analysis subtotaling the plots by RCTs vs. retrospective studies. (B) Forest plot (Random-effect model) of the stratified study conducted based on the severity of AP.

Mentions: In a pooled analysis of ten studies, we found that early EN significantly reduced all the infection complications as a whole compared with late EN or TPN (OR 0.38; 95%CI 0.21–0.68, P<0.05) but there was significant heterogeneity across all the studies (I2 = 48%, P<0.10; Figure 2A). The severity of AP was not stated in one study conducted by Olah A, et al [24]. And in another study conducted by Olah A, et al, both MAP and SAP patients were recruited, but the incidences of infection complications were not reported respectively, while just the total number of the cases was reported [29]. Hence, neither of these studies was fit for the stratified study. Finally, eight studies were included in the stratified study. Among them, seven articles were stratified into the pSAP or SAP sub-group, showing a significant reduction in all the infections with a smaller OR (0.34; 95%CI 0.15–0.77, P<0.05; Figure 2B) and significant heterogeneity was detected (I2 = 64%, P<0.10). But there was no subgroup difference between MAP subgroup and pSAP or SAP subgroup (P = 0.35).


Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis.

Li JY, Yu T, Chen GC, Yuan YH, Zhong W, Zhao LN, Chen QK - PLoS ONE (2013)

Effect of early EN on all the infection complications of AP as a whole.(A) Forest plot (Random-effect model) showing the effect of early EN on all the infection complications of AP as a whole and the sensitivity analysis subtotaling the plots by RCTs vs. retrospective studies. (B) Forest plot (Random-effect model) of the stratified study conducted based on the severity of AP.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3675100&req=5

pone-0064926-g002: Effect of early EN on all the infection complications of AP as a whole.(A) Forest plot (Random-effect model) showing the effect of early EN on all the infection complications of AP as a whole and the sensitivity analysis subtotaling the plots by RCTs vs. retrospective studies. (B) Forest plot (Random-effect model) of the stratified study conducted based on the severity of AP.
Mentions: In a pooled analysis of ten studies, we found that early EN significantly reduced all the infection complications as a whole compared with late EN or TPN (OR 0.38; 95%CI 0.21–0.68, P<0.05) but there was significant heterogeneity across all the studies (I2 = 48%, P<0.10; Figure 2A). The severity of AP was not stated in one study conducted by Olah A, et al [24]. And in another study conducted by Olah A, et al, both MAP and SAP patients were recruited, but the incidences of infection complications were not reported respectively, while just the total number of the cases was reported [29]. Hence, neither of these studies was fit for the stratified study. Finally, eight studies were included in the stratified study. Among them, seven articles were stratified into the pSAP or SAP sub-group, showing a significant reduction in all the infections with a smaller OR (0.34; 95%CI 0.15–0.77, P<0.05; Figure 2B) and significant heterogeneity was detected (I2 = 64%, P<0.10). But there was no subgroup difference between MAP subgroup and pSAP or SAP subgroup (P = 0.35).

Bottom Line: Eleven studies containing 775 patients with acute pancreatitis were analyzed.Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21-0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11-0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31-0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11-0.52, P<0.05), in the length of hospitalization (mean difference -2.18; 95%CI -3.48-(-0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14-0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05).The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT

Background: Enteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial. The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages.

Methods and findings: We searched PubMed, EMBASE Databases, Web of Science, the Cochrane library, and scholar.google.com for all the relevant articles about the effect of enteral nutrition initiated within 48 hours of admission on the clinical outcomes of acute pancreatitis from inception to December 2012. Eleven studies containing 775 patients with acute pancreatitis were analyzed. Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21-0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11-0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31-0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11-0.52, P<0.05), in the length of hospitalization (mean difference -2.18; 95%CI -3.48-(-0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14-0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05). The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05).

Conclusion: Enteral nutrition within 48 hours of admission is feasible and improves the clinical outcomes in acute pancreatitis as well as in predicted severe or severe acute pancreatitis by reducing complications.

Show MeSH
Related in: MedlinePlus