Impact of nutritional support routes on mortality in acute pancreatitis: A network meta-analysis of randomized controlled trials

IF 9 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Internal Medicine Pub Date : 2024-04-01 DOI:10.1111/joim.13782
Ping-Han Hsieh, Tsung-Chieh Yang, Enoch Yi-No Kang, Pei-Chang Lee, Jiing-Chyuan Luo, Yi-Hsiang Huang, Ming-Chih Hou, Shih-Ping Huang
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Abstract

Background

Nutritional administration in acute pancreatitis (AP) management has sparked widespread discussion, yet contradictory mortality results across meta-analyses necessitate clarification. The optimal nutritional route in AP remains uncertain. Therefore, this study aimed to compare mortality among nutritional administration routes in patients with AP using consistency model.

Methods

This study searched four major databases for relevant randomized controlled trials (RCTs). Two authors independently extracted and checked data and quality. Network meta-analysis was conducted for estimating risk ratios (RRs) with 95% confidence interval (CI) based on random-effects model. Subgroup analyses accounted for AP severity and nutrition support initiation.

Results

A meticulous search yielded 1185 references, with 30 records meeting inclusion criteria from 27 RCTs (n = 1594). Pooled analyses showed the mortality risk reduction associated with nasogastric (NG) (RR = 0.34; 95%CI: 0.16–0.73) and nasojejunal (NJ) feeding (RR = 0.46; 95%CI: 0.25–0.84) in comparison to nil per os. Similarly, NG (RR = 0.45; 95%CI: 0.24–0.83) and NJ (RR = 0.60; 95%CI: 0.40–0.90) feeding also showed lower mortality risk than total parenteral nutrition. Subgroup analyses, stratified by severity, supported these findings. Notably, the timing of nutritional support initiation emerged as a significant factor, with NJ feeding demonstrating notable mortality reduction within 24 and 48 h, particularly in severe cases.

Conclusion

For severe AP, both NG and NJ feeding appear optimal, with variations in initiation timings. NG feeding does not appear to merit recommendation within the initial 24 h, whereas NJ feeding is advisable within the corresponding timeframe following admission. These findings offer valuable insights for optimizing nutritional interventions in AP.

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营养支持途径对急性胰腺炎死亡率的影响:随机对照试验的网络荟萃分析。
背景:急性胰腺炎(AP)治疗中的营养管理引发了广泛的讨论,但荟萃分析中相互矛盾的死亡率结果需要澄清。急性胰腺炎的最佳营养途径仍不确定。因此,本研究旨在使用一致性模型比较胰腺炎患者不同营养给药途径的死亡率:本研究检索了四个主要数据库中的相关随机对照试验(RCT)。两位作者独立提取并检查数据和质量。根据随机效应模型进行网络荟萃分析,估计风险比(RRs)及95%置信区间(CI)。分组分析考虑了 AP 的严重程度和营养支持的启动情况:通过仔细检索,共获得 1185 篇参考文献,其中有 27 项 RCT(n = 1594)中的 30 条记录符合纳入标准。汇总分析结果表明,与 "无 "相比,鼻胃(NG)(RR = 0.34;95%CI:0.16-0.73)和鼻空肠(NJ)喂养(RR = 0.46;95%CI:0.25-0.84)可降低死亡率风险。同样,NG(RR = 0.45;95%CI:0.24-0.83)和 NJ(RR = 0.60;95%CI:0.40-0.90)喂养的死亡率也低于全肠外营养。按严重程度分层的亚组分析也支持这些发现。值得注意的是,营养支持的启动时间是一个重要因素,NJ喂养在24小时和48小时内显著降低了死亡率,尤其是在重症病例中:结论:对于重症 AP,NG 和 NJ 喂养似乎都是最佳选择,但开始时间有所不同。NG 喂养似乎不值得在最初的 24 小时内推荐,而 NJ 喂养则宜在入院后的相应时间内进行。这些发现为优化 AP 营养干预提供了宝贵的见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Internal Medicine
Journal of Internal Medicine 医学-医学:内科
CiteScore
22.00
自引率
0.90%
发文量
176
审稿时长
4-8 weeks
期刊介绍: JIM – The Journal of Internal Medicine, in continuous publication since 1863, is an international, peer-reviewed scientific journal. It publishes original work in clinical science, spanning from bench to bedside, encompassing a wide range of internal medicine and its subspecialties. JIM showcases original articles, reviews, brief reports, and research letters in the field of internal medicine.
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