Disease severity as a risk factor for enteral feeding intolerance in the early period of acute pancreatitis

Abstract

The purpose of the study was to assess the dependence of development of enteral nutrition intolerance on the disease form and condition severity during early AP with severe progression predictors. Materials and Methods. An open randomized controlled study has been carried out. The study included 64 patients, 31 of them having a severe and 33 — moderately severe forms of the disease. The criteria of enteral nutrition intolerance were: discharge via the nasogastric tube > 500ml simultaneously or > 500 ml/day, compared to the amount fed enterally over 24hrs; aggravation of pain; abdominal distension, diarrhea, nausea and vomiting. Indices possessing a predictive value were identified with the help of logit regression. The null hypothesis was rejected at p<0.05.Results. The APACHE-II score (OR — 1.134, 95% CI: 1.068-1.2, p=0.01) and CPR concentration (OR — 1.006, 95% CI: 1.005-1.013, p=0.001) affect independently the development of a large gastric residual volume. The fact of surgery predicts large gastric residual volumes (OR — 1.821, 95% CI: 2.529-9.19, p=0.001), nausea and vomiting (OR — 2.077, 95% CI: 1.075-4.012, p=0.021). The SOFA score is associated with large gastric residual volumes (OR — 1.349, 95% CI: 1.18-1.539, p= 0.001), pain (OR — 1.203, 95% CI: 1.065-1.364, p= 0.003), nausea and vomiting (OR — 1.167, 95% CI: 1.028-1.324, p= 0.018). The moderately severe form is accompanied with a lower incidence of large gastric residual volumes (OR — 0.354, 95% CI: 0.201-0.611, p=0.001), pain (OR — 0.475, 95% CI: 0.284-0.795, p=0.004), nausea and vomiting (OR — 0.519, 95% CI: 0.304-0.888, p=0.018), and abdominal distension (OR — 0.342, 95% CI: 0.193-0.607, p=0.001). Conclusions. The development and severity of early enteral nutrition intolerance during early acute pancreatitis with severe progression predictors depend on the severity of condition (APACHE-II), extent of multiple organ dysfunction (SOFA), the fact of surgery, form of the disease, and C-reactive protein concentration. A combined use of independent factors increases their predictive value.