Timing of enteral nutrition in acute pancreatitis: Meta-analysis of individuals using a single-arm of randomised trials

Olaf J. Bakker, Sandra Van Brunschot, Antoni Farre, Colin D. Johnson, Fotis Kalfarentzos, Brian E. Louie, A. Oláh, Stephen J. O'Keefe, Maxim S. Petrov, James J. Powell, Marc G. Besselink, Hjalmar C. Van Santvoort, Maroeska M. Rovers, Hein G. Gooszen

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23 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)340-346
Number of pages7
JournalPancreatology
Volume14
Issue number5
DOIs
Publication statusPublished - Sep 1 2014

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Enteral Nutrition
Pancreatitis
Meta-Analysis
Necrosis
Odds Ratio
Confidence Intervals
Mortality
Parenteral Nutrition
Logistic Models

Keywords

  • Acute pancreatitis
  • Enteral nutrition
  • Meta-analysis
  • Necrosis
  • Organ failure Infected necrosis

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Medicine(all)

Cite this

Bakker, O. J., Van Brunschot, S., Farre, A., Johnson, C. D., Kalfarentzos, F., Louie, B. E., ... Gooszen, H. G. (2014). Timing of enteral nutrition in acute pancreatitis: Meta-analysis of individuals using a single-arm of randomised trials. Pancreatology, 14(5), 340-346. https://doi.org/10.1016/j.pan.2014.07.008

Timing of enteral nutrition in acute pancreatitis : Meta-analysis of individuals using a single-arm of randomised trials. / Bakker, Olaf J.; Van Brunschot, Sandra; Farre, Antoni; Johnson, Colin D.; Kalfarentzos, Fotis; Louie, Brian E.; Oláh, A.; O'Keefe, Stephen J.; Petrov, Maxim S.; Powell, James J.; Besselink, Marc G.; Van Santvoort, Hjalmar C.; Rovers, Maroeska M.; Gooszen, Hein G.

In: Pancreatology, Vol. 14, No. 5, 01.09.2014, p. 340-346.

Research output: Contribution to journalArticle

Bakker, OJ, Van Brunschot, S, Farre, A, Johnson, CD, Kalfarentzos, F, Louie, BE, Oláh, A, O'Keefe, SJ, Petrov, MS, Powell, JJ, Besselink, MG, Van Santvoort, HC, Rovers, MM & Gooszen, HG 2014, 'Timing of enteral nutrition in acute pancreatitis: Meta-analysis of individuals using a single-arm of randomised trials', Pancreatology, vol. 14, no. 5, pp. 340-346. https://doi.org/10.1016/j.pan.2014.07.008
Bakker, Olaf J. ; Van Brunschot, Sandra ; Farre, Antoni ; Johnson, Colin D. ; Kalfarentzos, Fotis ; Louie, Brian E. ; Oláh, A. ; O'Keefe, Stephen J. ; Petrov, Maxim S. ; Powell, James J. ; Besselink, Marc G. ; Van Santvoort, Hjalmar C. ; Rovers, Maroeska M. ; Gooszen, Hein G. / Timing of enteral nutrition in acute pancreatitis : Meta-analysis of individuals using a single-arm of randomised trials. In: Pancreatology. 2014 ; Vol. 14, No. 5. pp. 340-346.
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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.",
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T1 - Timing of enteral nutrition in acute pancreatitis

T2 - Meta-analysis of individuals using a single-arm of randomised trials

AU - Bakker, Olaf J.

AU - Van Brunschot, Sandra

AU - Farre, Antoni

AU - Johnson, Colin D.

AU - Kalfarentzos, Fotis

AU - Louie, Brian E.

AU - Oláh, A.

AU - O'Keefe, Stephen J.

AU - Petrov, Maxim S.

AU - Powell, James J.

AU - Besselink, Marc G.

AU - Van Santvoort, Hjalmar C.

AU - Rovers, Maroeska M.

AU - Gooszen, Hein G.

PY - 2014/9/1

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N2 - 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.

AB - 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.

KW - Acute pancreatitis

KW - Enteral nutrition

KW - Meta-analysis

KW - Necrosis

KW - Organ failure Infected necrosis

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