Prognostic Tests for Early Enteral Nutrition Feeding Intolerance during Early Acute Pancreatitis with Severe Illness Predictors

Abstract

The objective: to assess the acetaminophen absorption test and gastric emptying rate as predictive criteria of enteral nutrition feeding intolerance during the early acute pancreatitis with severe illness predictors. Subjects and Methods. An open prospective cohort study was carried out in ICU of AO Neftyanik Hospital, in Tyumen from November 2012 to October 2018. The inclusion criteria were as follows: the diagnosed acute pancreatitis and presence of a severe illness predictor. The gastric emptying rate was estimated using an original technique wherein sonography was performed after administration of 200 ml of water into the gaster and subsequent assessment of the volume in 30 min. and 60 min. Acetaminophen absorption was assessed based on drug concentration in the blood 1 5-3 0 min. after its administration into the gaster. Results. The gastric liquid volume on minute 30 ( OR 1.061, 95% CI 1.03 3-1 .089, p < 0.001 with AUC 0.835, 95% CI 0.75 2-0 .918 with a cu t-o ff value of 136) and minute 60 ( OR 1.131, 95% CI 1.0 2-1 .043, p < 0.001 with AUC 0.826, 95% CI 0.72 8-0 .924 with a cu t-o ff value of 60.5) after liquid administration allows a statistically significant prediction of the residual gastric volume ≥ 500 m l/d ay and enteral nutrition feeding intolerance: OR 1.032, 95% CI 1.01 3-1 .051, p = 0.001 with AUC 0.727, 95% CI 0.62 8-0 ,827 with a cu t-o ff value of 133 and OR 1.032, 95% CI 1.01 8-1 .047, p < 0.001 with AUC 0.762, 95% CI 0.66 7-0 .857 with a cu t-o ff value of 56, respectively. The acetaminophen absorption test statistically significantly predicts the residual gastric volume ≥ 500 m l/d ay ( OR 0.686, 95% CI 0.58 3-0 .806, p < 0.001 with AUC 0.854, 95% CI 0.77 7-0 .931 with a cu t-o ff value of 6.96) and enteral nutrition feeding intolerance ( OR 0.626, 95% CI 0.52 2-0 .749, p < 0.001 with AUC 0.893, 95% CI 0.82 8-0 .958 with a cu t-o ff value of 7.6). Conclusions. The gastric water emptying rate and acetaminophen absorption test allow predicting gavage feeding intolerance during early acute pancreatitis with severe illness predictors. The acetaminophen absorption test has a higher predictive power.