Olaf J Bakker1, Sandra van Brunschot2, Antoni Farre3, Colin D Johnson4, Fotis Kalfarentzos5, Brian E Louie6, Attila Oláh7, Stephen J O'Keefe8, Maxim S Petrov9, James J Powell10, Marc G Besselink11, Hjalmar C van Santvoort12, Maroeska M Rovers2, Hein G Gooszen2. 1. Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: o.j.bakker@pancreatitis.nl. 2. Dept. of Operation Theatres and Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 3. Dept. of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 4. Dept. of Surgery, Southampton General Hospital, University of Southampton, UK. 5. Dept. of Surgery, Nutritional and Metabolic Unit, University of Patras, Patras, Greece. 6. Dept. of Thoracic Surgery, Swedish Cancer Instititute and Medical Center, Seattle, WA, USA. 7. Dept. of Surgery, Petz Aladár Teaching Hospital, Györ, Hungary. 8. Physicians Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh, PA, USA. 9. Dept. of Surgery, University of Auckland, Auckland, New Zealand. 10. Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK. 11. Dept. of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands. 12. Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
INTRODUCTION: In acute pancreatitis, enteral nutrition (EN) reduces the rate of complications, such as infected pancreatic necrosis, organ failure, and mortality, as compared to parenteral nutrition (PN). Starting EN within 24 h of admission might further reduce complications. METHODS: A literature search for trials of EN in acute pancreatitis was performed. Authors of eligible trials were requested to provide the data of all patients in the EN-arm of their trials. A meta-analysis of individual patient data was performed. The cohort of patients with EN was divided into patients receiving EN within 24 h or after 24 h of admission. Multivariable logistic regression, adjusting for predicted disease severity and trial, was used to study the effect of timing of EN on a composite endpoint of infected pancreatic necrosis, organ failure, or mortality. RESULTS: Observational data from 165 individuals from 8 randomised trials were obtained; 100 patients with EN within 24 h and 65 patients with EN after 24 h of admission. In the multivariable model, EN started within 24 h of admission compared to EN started after 24 h of admission, reduced the composite endpoint from 45% to 19% (adjusted odds ratio [OR] of 0.44; 95% confidence interval [CI] 0.20-0.96). Within the composite endpoint, organ failure was reduced from 42% to 16% (adjusted OR 0.42; 95% CI 0.19-0.94). CONCLUSIONS: In this meta-analysis of observational data from individuals with acute pancreatitis, starting EN within 24 h after hospital admission, compared with after 24 h, was associated with a reduction in complications.
INTRODUCTION: In acute pancreatitis, enteral nutrition (EN) reduces the rate of complications, such as infected pancreatic necrosis, organ failure, and mortality, as compared to parenteral nutrition (PN). Starting EN within 24 h of admission might further reduce complications. METHODS: A literature search for trials of EN in acute pancreatitis was performed. Authors of eligible trials were requested to provide the data of all patients in the EN-arm of their trials. A meta-analysis of individual patient data was performed. The cohort of patients with EN was divided into patients receiving EN within 24 h or after 24 h of admission. Multivariable logistic regression, adjusting for predicted disease severity and trial, was used to study the effect of timing of EN on a composite endpoint of infected pancreatic necrosis, organ failure, or mortality. RESULTS: Observational data from 165 individuals from 8 randomised trials were obtained; 100 patients with EN within 24 h and 65 patients with EN after 24 h of admission. In the multivariable model, EN started within 24 h of admission compared to EN started after 24 h of admission, reduced the composite endpoint from 45% to 19% (adjusted odds ratio [OR] of 0.44; 95% confidence interval [CI] 0.20-0.96). Within the composite endpoint, organ failure was reduced from 42% to 16% (adjusted OR 0.42; 95% CI 0.19-0.94). CONCLUSIONS: In this meta-analysis of observational data from individuals with acute pancreatitis, starting EN within 24 h after hospital admission, compared with after 24 h, was associated with a reduction in complications.