Risk factors for enteral nutrition intolerance and its impact on prognosis in patients with severe acute pancreatitis

doi:10.4240/wjgs.v18.i1.112334

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Jan 27, 2026; 18(1): 112334
Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.112334

Risk factors for enteral nutrition intolerance and its impact on prognosis in patients with severe acute pancreatitis

Chang-Mei Wu, Wen-Jun Zhu, Xi Chen, Min Liu, Yuan Feng, Mei Wang

Chang-Mei Wu, Wen-Jun Zhu, Xi Chen, Min Liu, Yuan Feng, Mei Wang, Department of Emergency Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China

Co-first authors: Chang-Mei Wu and Wen-Jun Zhu.

Author contributions: Wu CM and Zhu WJ did conceptualization, data curation, investigation, and writing the original draft, they contributed equally to this article, they are the co-first authors of this manuscript; Wu CM, Zhu WJ, and Chen X did formal analysis; Chen X, Liu M, and Feng Y did data collection; Liu M did investigation and software; Chen X and Feng Y did visualization; Wu CM, Zhu WJ, Feng Y, and Wang M did methodology; Wang M did conceptualization, project administration, supervision, writing review and editing, and funding acquisition; and all the authors have read and approved the final manuscript.

Institutional review board statement: This study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Anhui Medical University, approval No. PJ2024-05-90.

Informed consent statement: All patient information was anonymized and de-identified prior to analysis. The requirement for signed informed consent was waived by the institutional review board due to the retrospective nature of the study and minimal risk to participants.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: De-identified data and analysis code used in this study are available from the corresponding author upon reasonable request and with appropriate institutional approvals.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Mei Wang, MD, Department of Emergency Medicine, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Shushan District, Hefei 230022, Anhui Province, China. mei_wang7065@sina.com

Received: August 15, 2025
Revised: September 24, 2025
Accepted: December 1, 2025
Published online: January 27, 2026
Processing time: 159 Days and 1.9 Hours

Abstract

BACKGROUND

Severe acute pancreatitis (SAP) affects 10%-20% of acute pancreatitis patients, with mortality rates of up to 30%, requiring early enteral nutrition (EN) within 24-48 hours per the European Society for Clinical Nutrition and Metabolism guidelines. However, intolerance to EN occurs in 25%-40% of SAP patients due to gastrointestinal dysfunction, leading to prolonged intensive care unit stays, increased infections, and compromised survival outcomes.

AIM

To investigate the risk factors for EN intolerance in patients with SAP and its impact on prognosis, providing evidence for clinical nutrition therapy strategies.

METHODS

A retrospective cohort study design was adopted, and the clinical data of 195 SAP patients of our hospital were collected from January 2019 to June 2025. Patients were divided into an intolerance group (76 patients) and a tolerance group (119 patients) according to their EN intolerance status. Multivariate logistic regression analysis was used to identify independent risk factors for EN intolerance, and a Cox proportional hazards regression model was used to analyze independent factors affecting 28-day mortality.

RESULTS

The incidence of EN intolerance in SAP patients was 39.0%. Multivariate logistic regression analysis revealed that the Acute Physiology and Chronic Health Evaluation II score [odds ratio (OR) = 1.124, 95% confidence interval (CI): 1.042-1.213, P = 0.002], serum albumin level (OR = 0.879, 95%CI: 0.801-0.965, P = 0.006), and intra-abdominal pressure (OR = 1.152, 95%CI: 1.063-1.248, P = 0.001) were independent risk factors for EN intolerance. The 28-day mortality rate in the intolerance group was significantly greater than that in the tolerance group (25.0% vs 12.6%, P = 0.025). Cox regression analysis revealed that EN intolerance (hazard ratio = 2.164, 95%CI: 1.127-4.156, P = 0.020) was an independent risk factor for 28-day mortality

CONCLUSION

The incidence of EN intolerance in SAP patients is high, with the Acute Physiology and Chronic Health Evaluation II score, serum albumin level, and intra-abdominal pressure being independent risk factors. EN intolerance significantly increases the risk of mortality in patients and is an independent risk factor affecting prognosis. Early identification of high-risk factors and the development of individualized nutrition therapy strategies are crucial for improving patient outcomes.

Keywords: Severe acute pancreatitis; Enteral nutrition; Intolerance; Risk factors; Prognosis

Core Tip: The incidence, risk factors, and prognostic significance of enteral nutrition (EN) intolerance in patients with severe acute pancreatitis were examined in this retrospective cohort study. The rate of EN intolerance among 195 patients was 39.0%. Multivariate analysis revealed that the Acute Physiology and Chronic Health Evaluation II score, serum albumin concentration, and intra-abdominal pressure were independent predictors. Patients with EN intolerance had significantly greater 28-day mortality. In addition to offering evidence for the optimization of EN therapy in critical care settings, these findings emphasize the significance of early risk assessment and customized nutritional measures to enhance outcomes for severe acute pancreatitis patients.