Abstract
BackgroundAlthough enteral nutrition has become one of the standard therapies for patients with acute pancreatitis, the optimal formulae for enteral nutrition have been under debate. Elemental formula is assumed to be suitable in the treatment of patients with acute pancreatitis because it has less stimulating effects for exocrine secretions of the pancreas, simultaneously maintaining gut immunity; however, clinical studies corroborating this assumption have been scarce.MethodsWe conducted a retrospective cohort study using a Japanese national administrative database between 2010 and 2015. Patients with acute pancreatitis who received enteral feeding within 3 days of admission were identified and divided into two groups according to whether elemental formula was administered. We assessed the impact of elemental formula for the outcomes (primary, in-hospital mortality; secondary, development of sepsis, hospital-free days at 90 days, and total health-care costs) using a multivariate mixed-effect regression analysis and propensity score matching analysis adjusted by a well-validated case-mix adjustment model. Analysis for the subpopulation of patients with severe acute pancreatitis was also performed.ResultsOf 243,312 patients with acute pancreatitis, 948 patients were identified and classified into the elemental formula group (N = 382) and the control group (N = 566). No significant differences were observed for in-hospital mortality [10.2% in the elemental formula group vs. 11.0% in the control group; adjusted adds ratio (95% confidence interval; CI) = 0.94 (0.53–1.67)], sepsis development [5.0 vs. 7.1%; adjusted adds ratio (95% CI) = 0.66 (0.34–1.28)], mean hospital-free days [54 days vs. 51 days; adjusted difference (95% CI) = 2 days (− 2 to 5)], and mean total health-care costs [$29,360 vs. $34,214; adjusted difference (95% CI) = − $4250 (− 8643 to 141)]. Similar results were also observed in patients with severe acute pancreatitis.ConclusionsThe results of our retrospective cohort study using a large-scale national database did not demonstrate the benefit of elemental formula compared to semi-elemental and polymeric formulae in patients with acute pancreatitis. Further assessment of alternative nutritional strategy is expected.
Highlights
Enteral nutrition has become one of the standard therapies for patients with acute pancreatitis, the optimal formulae for enteral nutrition have been under debate
Because few randomized controlled trial (RCT) or large-scale cohort studies have been reported in this theme, Petrov et al [13] performed an indirect adjusted meta-analysis, in which parenteral nutrition groups were used as the reference and reported that significant difference regarding survival benefit and adverse events were not observed between the groups ofelemental formulae and polymeric formula
Statistical analysis We developed a risk adjustment model for in-hospital mortality using the variables of age, sex, Charlson comorbidity index, prognostic factor score, computed tomography (CT) severity score, mechanical ventilation within 3 days of admission, renal replacement therapy within 3 days of admission, transfusion within 3 days of admission, and vasopressor use within 3 days of admission by applying a logistic regression model that included a random sample of 80% of the entire study cohort
Summary
Enteral nutrition has become one of the standard therapies for patients with acute pancreatitis, the optimal formulae for enteral nutrition have been under debate. Elemental formula is assumed to be suitable in the treatment of patients with acute pancreatitis because it has less stimulating effects for exocrine secretions of the pancreas, simultaneously maintaining gut immunity; clinical studies corroborating this assumption have been scarce. The concept of “pancreatic rest” had been widely believed to be the standard nutritional strategy in the management of acute pancreatitis; total parenteral nutrition had been widely used up to the 1990s [6, 7]. To our knowledge, a large RCT or cohort study that directly compared the efficacy of elemental formula has not been reported in the treatment of acute pancreatitis. We aimed to assess the clinical benefit of elemental formula compared to the other formulae (semi-elemental and polymeric formulae) in the initiation of enteral nutrition management in acute pancreatitis, using a large-scale national administrative database
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