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Sun JK, Lv C, Gao L, Mao W, Li W, Ke L. Nutrition therapy in critically ill patients with severe acute pancreatitis. Nutr Clin Pract 2024; 39:271-280. [PMID: 38357829 DOI: 10.1002/ncp.11135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
A significant proportion of patients (10%-20%) with acute pancreatitis develop severe acute pancreatitis characterized by pancreatic necrosis, systemic inflammation, and organ failure, commonly requiring intensive care unit (ICU) admission. In this specific population, nutrition therapy is more challenging than that in the general ICU population, primarily because of inevitable gastrointestinal involvement by pancreatic inflammation. In this review, we discussed several key aspects of nutrition therapy in this population, including key pathophysiology that may impede nutrition therapy, the timing and implementation of enteral nutrition and parenteral nutrition, the importance of specific nutrient supplements, and the long-term outcomes that may be addressed by nutrition therapy.
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Affiliation(s)
- Jia-Kui Sun
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Cheng Lv
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
| | - Lin Gao
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
| | - Wenjian Mao
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue At, Nanjing University, Nanjing, Jiangsu Province, China
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Tarján D, Szalai E, Lipp M, Verbói M, Kói T, Erőss B, Teutsch B, Faluhelyi N, Hegyi P, Mikó A. Persistently High Procalcitonin and C-Reactive Protein Are Good Predictors of Infection in Acute Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis. Int J Mol Sci 2024; 25:1273. [PMID: 38279274 PMCID: PMC10816999 DOI: 10.3390/ijms25021273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
Infected necrotizing pancreatitis (INP) is associated with an increased risk of organ failure and mortality. Its early recognition and timely initiation of antibiotic therapy can save patients' lives. We systematically searched three databases on 27 October 2022. In the eligible studies, the presence of infection in necrotizing pancreatitis was confirmed via a reference test, which involved either the identification of gas within the necrotic collection through computed tomography imaging or the examination of collected samples, which yielded positive results in Gram staining or culture. Laboratory biomarkers compared between sterile necrotizing pancreatitis and INP were used as the index test, and our outcome measures included sensitivity, specificity, the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). Within the first 72 hours (h) after admission, the AUC of C-reactive protein (CRP) was 0.69 (confidence interval (CI): 0.62-0.76), for procalcitonin (PCT), it was 0.69 (CI: 0.60-0.78), and for white blood cell count, it was 0.61 (CI: 0.47-0.75). After the first 72 h, the pooled AUC of CRP showed an elevated level of 0.88 (CI: 0.75-1.00), and for PCT, it was 0.86 (CI: 0.60-1.11). The predictive value of CRP and PCT for infection is poor within 72 h after hospital admission but seems good after the first 72 h. Based on these results, infection is likely in case of persistently high CRP and PCT, and antibiotic initiation may be recommended.
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Affiliation(s)
- Dorottya Tarján
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Eszter Szalai
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Mónika Lipp
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
| | - Máté Verbói
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, 1111 Budapest, Hungary
| | - Bálint Erőss
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Department of Radiology, Medical Imaging Centre, Semmelweis University, 1085 Budapest, Hungary
| | - Nándor Faluhelyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Division of Medical Imaging, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation, University of Szeged, 6725 Szeged, Hungary
| | - Alexandra Mikó
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation, University of Szeged, 6725 Szeged, Hungary
- Department for Medical Genetics, Medical School, University of Pécs, 7624 Pécs, Hungary
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