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Meta-Analysis
. 2013 Jun 6;8(6):e64926.
doi: 10.1371/journal.pone.0064926. Print 2013.

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

Jie-Yao Li  1 , Tao Yu, Guang-Cheng Chen, Yu-Hong Yuan, Wa Zhong, Li-Na Zhao, Qi-Kui Chen
Affiliations
Meta-Analysis

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

Jie-Yao Li et al. PLoS One. .

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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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of literature search for meta-analysis.
Figure 2
Figure 2. 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.
Figure 3
Figure 3. Effect of early EN on catheter-related septic complications of AP.
(A) Forest plot (Fixed-effect model) showing the effect of early EN on catheter-related septic complications of AP and the sensitivity analysis subtotaling the plots by RCTs vs. retrospective studies. (B) Forest plot (Fixed-effect model) of the stratified study conducted based on the severity of AP.
Figure 4
Figure 4. Effect of early EN on pancreatic infection complications of AP.
(A) Forest plot (Fixed-effect model) showing the effect of early EN on pancreatic infection complications of AP and the sensitivity analysis subtotaling the plots by RCTs vs. retrospective studies. (B) Forest plot (Fixed-effect model) of a selection of five articles recruiting patients of pSAP or SAP.
Figure 5
Figure 5. Forest plot showing the effect of early EN on the incidence of hyperglycemia in AP.
Fixed-effect model was applied.
Figure 6
Figure 6. Forest plot showing the effect of early EN on the OF rate in AP.
All the patients with OF were classified as pSAP or SAP previously. Fixed-effect model was applied and the sensitivity analysis subtotaling the plots by RCTs vs. retrospective studies was conducted.
Figure 7
Figure 7. Forest plot showing the effect of early EN on the LOH in AP.
Fixed-effect model was applied and the sensitivity analysis subtotaling the plots by RCTs vs. retrospective studies was conducted.
Figure 8
Figure 8. Forest plot showing the effect of early EN on the mortality in AP.
Fixed-effect model was applied and sensitivity analysis subtotaling the plots by RCTs vs. retrospective studies was conducted.
See this image and copyright information in PMC

References

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