| Background Severe acute pancreatitis(SAP)is one of the most serious diseases of the digestive system and is characterized by complex conditions,rapid progression,multiple complications and high mortality.Treatment duration for SAP is long,thus making nutritional support a key element in therapeutic schemes.Growing evidence has demonstrated that the use of enteral nutrition(EN)in SAP patients has several advantages,including effective protection of intestinal mucosa function,reduction of the displacement of intestinal microflora and toxins,shortening of disease course and cost reduction.The use of EN also lowers the incidence of infection and other complications and improves prognosis.Taken together,EN outperforms parenteral nutrition(PN)to be the ideal nutritional supply method in SAP patient.However,optimal timing to begin EN therapy in SAP treatment remains unclear and is still on debate.Aim To investigate the effect of early enteral nutrition at different time points on the clinical outcomes of SAP.Methods We retrospectively included SAP patients admitted to Shanghai Jiao Tong university affiliated Ruijin hospital during 2013 through 2016.Based on the time difference(T,days)of SAP onset and initiation of EN,patients were divided into two groups,group A(T<=5)and group B(5<T<14).We extracted data from medical records on EN initiation,as well as on the APACHE II score and SOFA score on admission at day 14 and day 28.Other patient profiles including total length of stay,operative rate,albumin and pre-albumin,28-day and 60-day mortality,acute kidney injury,acute respiratory distress syndrome,sepsis,abdominal compartment syndrome and pancreatic pseudocyst were also extracted.We analyzed and compared these data between group A and B.Results From January 2013 to December 2016,a total of 174 patients with SAP were admitted.Eight patients were excluded for older age(>80 years),twenty-one patients for pregnancy,history of malignancy,major surgery,severe trauma,chronic organ dysfunction or diseases of blood or immune system.Twenty-one patients were excluded for <14 days of hospitalization.Twenty-five patients were excluded for they were started EN after 14 days after disease onset,and one patient without EN was also excluded.A total of 98 patients were included in the final analysis.Among them 51 patients were in group A and 47 in group B.On the day of admission,the APACHE II score of group A and B were 11.06±2.21 vs 11.96±3.48,and SOFA score 3.69±1.11 vs 4.34±2.75,respectively.There was no significant difference between the two groups(p>0.05).The APACHE II score(7.02±1.85)and SOFA score(2.39±0.72)of group A patients were significantly lower in day 14 compared to admission day(p<0.05),and to those in group B(day 14 APACHEII score 8.68±3.7,SOFA score 3.34± 2.14,all p<0.05).The APACHEII score(5.33±1.24 vs 7.22±3.68)and SOFA score(1.47±0.53 vs 3.2±2.10)were significantly lower in group A than that in group B at day 28(p<0.05).At day 14 after onset,the differences in APACHE II score(4.04±2.12 vs 3.28±3.57)and SOFA score(1.29±0.9 vs 1±1.71)between groups A and B were not statistically significant(p>0.05).At day 28,the reduction of SOFA score was significantly greater in group A than that in group B(2.36±1.21 vs 1.27±2.72,p<0.05),while there was no significant difference in APACHE II score reduction(5.87±2.49 vs 4.78±4.18,p>0.05).The incidence of AKI in group A was significantly lower than that in group B(0 vs 15%,p<0.05),while the incidences of other complications such as acute respiratory distress,sepsis,ACS and pancreatic pseudocyst were not(p>0.05).On the day of admission,the pre-albumin(130.27 ± 52.58 vs 123.04 ± 67.14)had no significant difference between the two groups(p>0.05).However,the albumin in group A were significantly lower than those in group B(30.36±4.51 vs 33.72±4.85)(p<0.05).The pre-albumin of group A patients(258.77±80.30)were higher in day 14 compared to those in group B(196.76±93.37)(p<0.05),but had no significant difference in day 28.Patients in group A had significantly lower 60-day mortality compared to those in group B(13.7% vs 40.4%,p<0.05).However,the total duration of hospitalization(41.9±17.01 vs 44.85±22.30 days)and 28-day mortality(0 vs 4%)was not significantly different(p>0.05).Conclusion SAP patients who were initiated EN within five days after onset had a lower operative rate,lower rate of AKI,and lower 60-day mortality,a earlier advance in pre-albumin compared with those initiated EN after five days.Early initiation of EN within five days also significantly reduced APACHEII score and SOFA score,in which the decrease of SOFA score was more prominent.It recommends to start EN early in patients with SAP. |
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