Impact of Enteral Nutrition Within 24 Hours Versus Between 24 and 48 Hours in Patients With Severe Acute Pancreatitis: A Multicenter Retrospective Study

被引：26

作者：

Nakashima, Ikue ^{[1
]}

Horibe, Masayasu ^{[2
,3
]}

Sanui, Masamitsu ^{[4
]}

Sasaki, Mitsuhito ^{[5
]}

Sawano, Hirotaka ^{[6
]}

Goto, Takashi ^{[7
]}

Ikeura, Tsukasa ^{[8
]}

Takeda, Tsuyoshi ^{[9
]}

Oda, Takuya ^{[10
]}

Yasuda, Hideto ^{[11
]}

Ogura, Yuki ^{[3
]}

Miyazaki, Dai ^{[12
,13
]}

Kitamura, Katsuya ^{[14
,15
]}

Chiba, Nobutaka ^{[16
]}

Ozaki, Tetsu ^{[1
]}

Yamashita, Takahiro ^{[17
]}

Koinuma, Toshitaka ^{[18
]}

Oshima, Taku ^{[19
]}

Yamamoto, Tomonori ^{[20
]}

Hirota, Morihisa ^{[21
]}

Moriya, Takashi ^{[22
]}

Shirai, Kunihiro ^{[23
]}

Izai, Junko ^{[24
]}

Takeda, Kazunori ^{[25
]}

Sekino, Motohiro ^{[26
]}

Iwasaki, Eisuke ^{[2
]}

Kanai, Takanori ^{[2
]}

Mayumi, Toshihiko ^{[27
]}

机构：

[1] Saiseikai Kumamoto Hosp, Dept Acute Care & Gen Med, Kumamoto, Japan

[2] Keio Univ, Div Gastroenterol & Hepatol, Dept Internal Med, Sch Med, Tokyo, Japan

[3] Tokyo Metropolitan Tama Med Ctr, Dept Gastroenterol & Hepatol, Tokyo, Japan

[4] Jichi Med Univ, Dept Anesthesiol & Crit Care Med, Saitama Med Ctr, 1-847 Amanuma, Saitama 3308503, Japan

[5] Natl Canc Ctr, Dept Hepatobiliary & Pancreat Oncol, Tokyo, Japan

[6] Osaka Saiseikai Senri Hosp, Senri Crit Care Med Ctr, Osaka, Japan

[7] Hiroshima City Hiroshima Citizens Hosp, Dept Anesthesiol & Intens Care, Hiroshima, Japan

[8] Kansai Med Univ, Dept Internal Med 3, Osaka, Japan

[9] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[10] Iizuka Hosp, Dept Gen Internal Med, Fukuoka, Japan

[11] Japanese Red Cross Musashino Hosp, Dept Emergency & Crit Care Med, Tokyo, Japan

[12] Japanese Red Cross Maebashi Hosp, Adv Emergency Med & Crit Care Ctr, Gunma, Japan

[13] Harima Rehabil Program Ctr, Dept Med, Kakogawa, Hyogo, Japan

[14] Tokyo Med Univ, Dept Gastroenterol & Hepatol, Hachioji Med Ctr, Tokyo, Japan

[15] Showa Univ, Div Gastroenterol, Dept Med, Sch Med, Tokyo, Japan

[16] Nihon Univ Hosp, Dept Emergency & Crit Care Med, Tokyo, Japan

[17] Fukuyama City Hosp, Emergency Med Ctr, Hiroshima, Japan

[18] Jichi Med Univ, Div Intens Care, Dept Anesthesiol & Intens Care Med, Sch Med, Shimotsuke, Tochigi, Japan

[19] Chiba Univ, Dept Emergency & Crit Care Med, Grad Sch Med, Chiba, Japan

[20] Osaka City Univ, Grad Sch Med, Dept Traumatol & Crit Care Med, Osaka, Japan

[21] Tohoku Univ Hosp, Div Gastroenterol, Sendai, Miyagi, Japan

[22] Nihon Univ, Div Emergency & Crit Care Med, Dept Acute Med, Sch Med, Tokyo, Japan

[23] Gifu Univ, Grad Sch Med, Dept Emergency & Disaster Med, Gifu, Japan

[24] Saka Gen Hosp, Dept Surg, Shiogama, Miyagi, Japan

[25] Hlth Insurance Claims Review & Reimbursement Serv, Miyagi Branch Off, Sendai, Miyagi, Japan

[26] Nagasaki Univ Hosp, Div Intens Care, Nagasaki, Japan

[27] Univ Occupat & Environm Hlth, Sch Med, Dept Emergency Med, Fukuoka, Japan

来源：

PANCREAS | 2021年 / 50卷 / 03期

关键词：

early enteral nutrition; late enteral nutrition; mortality; AP - acute pancreatitis; APACHE - Acute Physiology and Chronic Health Evaluation; CI - confidence interval; CT - computed tomography; CTSI - computed tomography severity index; EN - enteral nutrition; !text type='JS']JS[!/text]S - Japanese Severity Score; OR - odds ratio; SAP - severe acute pancreatitis; UMIN - University Hospital Medical Information Network; TOTAL PARENTERAL-NUTRITION; NECROTIZING PANCREATITIS; METAANALYSIS; GUIDELINES; MANAGEMENT; EFFICACY; OUTCOMES; RISK;

D O I：

10.1097/MPA.0000000000001768

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Objectives In patients with severe acute pancreatitis (SAP), early enteral nutrition (EN) is recommended by major clinical practice guidelines, but the exact timing for the initiation of EN is unknown. Methods We conducted a post hoc analysis of the database for a multicenter (44 institutions) retrospective study of patients with SAP in Japan. The patients were classified into 3 groups according to the timing of EN initiation after the diagnosis of SAP: within 24 hours, between 24 and 48 hours, and more than 48 hours. The primary outcome was in-hospital mortality. Results Of the 1094 study patients, 176, 120, and 798 patients started EN within 24 hours, between 24 and 48 hours, and more than 48 hours after SAP diagnosis, respectively. On multivariable analysis, hospital mortality was significantly better with EN within 48 hours than with more than 48 hours (adjusted odds ratio, 0.49; 95% confidence interval, 0.29-0.83; P < 0.001) but did not significantly differ between the groups with EN starting within 24 hours and between 24 and 48 hours (P = 0.29). Conclusions Enteral nutrition within 24 hours may not confer any additional benefit on clinical outcomes compared with EN between 24 and 48 hours.

引用

页码：371 / 377

页数：7

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