Author(s):
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Bakker, O.J.; Brunschot, S. van; Farre, A.; Johnson, C.D.; Kalfarentzos, F.; Louie, B.E.; Olah, A.; O'Keefe, S.J.; Petrov, M.S.; Powell, J.J.; Besselink, M.G.;
Santvoort, H.C. van
;
Rovers, M.M.
;
Gooszen, H.G.
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Subject:
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Radboudumc 14: Tumours of the digestive tract RIHS: Radboud Institute for Health Sciences Radboudumc 15: Urological cancers RIHS: Radboud Institute for Health Sciences |
Organization:
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Operating Rooms Health Evidence |
Abstract:
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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.
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