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

Table 1 Comparison of baseline characteristics between two groups, n (%)

Characteristics	Intolerance group (n = 76)	Tolerance group (n = 119)	Test statistic	P value
Age (years), mean ± SD	54.1 ± 15.2	51.2 ± 14.3	1.328	0.186
Gender			0.234	0.629
Male	48 (63.2)	80 (67.2)
Female	28 (36.8)	39 (32.8)
BMI (kg/m²), mean ± SD	24.8 ± 3.6	24.2 ± 3.4	1.142	0.255
Medical history
Diabetes	18 (23.7)	25 (21.0)	0.186	0.666
Hypertension	32 (42.1)	45 (37.8)	0.355	0.551
Cardiovascular disease	14 (18.4)	19 (16.0)	0.189	0.663
Etiology			3.847	0.279
Biliary	38 (50.0)	51 (42.9)
Alcoholic	18 (23.7)	34 (28.6)
Hyperlipidemic	14 (18.4)	17 (14.3)
Idiopathic	6 (7.9)	17 (14.3)
Time from onset to admission (hour), mean ± SD	16.8 ± 7.2	14.2 ± 6.1	2.541	0.012
Time from admission to ICU (hour), mean ± SD	11.4 ± 4.8	9.1 ± 3.7	3.658	0.001

BMI: Body mass index; ICU: Intensive care unit.

Table 2 Comparison of disease severity between two groups, n (%)

Indicators	Intolerance group (n = 76)	Tolerance group (n = 119)	Test statistic	P value
APACHE II score, mean ± SD	21.8 ± 6.4	18.2 ± 5.7	4.083	< 0.001
SOFA score, mean ± SD	8.6 ± 3.2	6.9 ± 2.8	3.884	< 0.001
MCTSI score, mean ± SD	7.4 ± 2.1	6.1 ± 2.3	3.946	< 0.001
Number of organ failures, mean ± SD	2.3 ± 1.1	1.8 ± 0.9	3.203	0.002
Types of organ failure
Respiratory	68 (89.5)	89 (74.8)	6.648	0.010
Circulatory	52 (68.4)	61 (51.3)	5.428	0.020
Renal	41 (53.9)	44 (37.0)	5.135	0.023
Hepatic	29 (38.2)	32 (26.9)	2.637	0.104
Hematologic	18 (23.7)	19 (16.0)	1.813	0.178
Neurologic	12 (15.8)	14 (11.8)	0.694	0.405

APACHE: Acute Physiology and Chronic Health Evaluation; SOFA: Sequential organ failure assessment; MCTSI: Modified computed tomography severity index.

Table 3 Comparison of laboratory parameters between two groups, mean ± SD

Indicators	Intolerance group (n = 76)	Tolerance group (n = 119)	Test statistic	P value
Inflammatory markers
WBC count (× 109/L)	16.8 ± 6.2	14.2 ± 5.4	3.074	0.002
Neutrophil (%)	82.4 ± 8.6	78.9 ± 9.2	2.664	0.008
CRP (mg/L)1	186.4 (98.2, 274.6)	142.6 (76.8, 208.4)	-4.247	< 0.001
PCT (μg/L)1	3.8 (1.6, 8.2)	2.1 (0.8, 4.9)	-3.247	0.001
Pancreatic enzymes
Serum amylase (U/L)1	428 (186, 862)	384 (168, 726)	-1.428	0.153
Lipase (U/L)1	1246 (542, 2184)	1087 (468, 1896)	-1.723	0.085
Nutritional markers
Serum albumin (g/L)	26.8 ± 4.2	29.1 ± 4.8	-3.384	0.001
Prealbumin (μg/mL)	148.6 ± 32.4	168.2 ± 38.7	-3.689	< 0.001
Hemoglobin (g/L)	108.4 ± 18.6	112.8 ± 20.2	-1.534	0.126
Organ function markers
ALT (U/L)1	89.6 (42.8, 156.4)	68.2 (35.4, 128.6)	-2.146	0.032
AST (U/L)1	106.8 (58.2, 178.4)	84.6 (46.8, 142.2)	-2.218	0.026
Total bilirubin (μmol/L)1	48.6 (22.4, 86.8)	36.4 (18.2, 64.2)	-2.364	0.018
Serum creatinine (μmol/L)1	142.8 (86.4, 208.6)	108.2 (68.4, 156.8)	-2.968	0.003
BUN (mmol/L)1	12.4 (7.8, 18.6)	9.2 (5.6, 14.8)	-2.642	0.008
PT (second)	16.8 ± 4.2	14.6 ± 3.8	3.724	0.001
APTT (second)	42.6 ± 8.4	38.2 ± 7.6	3.698	0.001
INR1	1.52 (1.18, 1.96)	1.24 (1.06, 1.58)	-3.842	< 0.001
Metabolic markers
Blood glucose (mmol/L)	12.8 ± 4.6	10.4 ± 3.8	3.847	0.001
Serum sodium (mmol/L)	138.4 ± 6.8	140.2 ± 5.4	-1.984	0.048
Serum potassium (mmol/L)	3.8 ± 0.8	3.9 ± 0.7	-0.924	0.357
Serum chloride (mmol/L)	102.4 ± 8.2	104.1 ± 7.6	-1.468	0.144
Lactate (mmol/L)	2.8 ± 1.4	2.2 ± 1.1	3.242	0.001

¹Non-normally distributed data, expressed as median (interquartile range).

WBC: White blood cell; CRP: C-reactive protein; PCT: Procalcitonin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BUN: Blood urea nitrogen; PT: Prothrombin time; APTT: Activated partial thromboplastin time; INR: International normalized ratio.

Table 4 Comparison of nutrition therapy-related indicators between two groups, n (%)

Indicators	Intolerance group (n = 76)	Tolerance group (n = 119)	Test statistic	P value
Nutrition route			17.428	< 0.001
Gastric feeding	34 (44.7)	89 (74.8)
Jejunal feeding	42 (55.3)	30 (25.2)
Tube type			21.846	< 0.001
Nasogastric tube	32 (42.1)	78 (65.5)
Nasojejunal tube	38 (50.0)	35 (29.4)
PEG	6 (7.9)	6 (5.0)
Nutrition initiation time (hour), mean ± SD	38.4 ± 12.8	32.6 ± 10.4	3.368	0.001
Time to achieve target energy (day), mean ± SD	8.4 ± 3.2	4.6 ± 2.1	9.548	< 0.001
Target energy achievement rate (%), mean ± SD	68.4 ± 18.6	86.2 ± 14.8	-7.084	< 0.001
Daily actual energy intake (kcal/kg), mean ± SD	18.2 ± 6.4	24.8 ± 5.2	-7.652	< 0.001
Daily protein intake (g/kg), mean ± SD	0.9 ± 0.4	1.3 ± 0.3	-8.043	< 0.001
Nutrition interruption frequency, mean ± SD	3.8 ± 2.4	1.2 ± 1.6	8.426	< 0.001
Parenteral nutrition supplementation ratio (%), mean ± SD	42.6 ± 18.4	18.2 ± 12.6	10.254	< 0.001

PEG: Percutaneous endoscopic gastrostomy.

Table 5 Comparison of treatment measures between two groups, n (%)

Indicators	Intolerance group (n = 76)	Tolerance group (n = 119)	Test statistic	P value
Respiratory support
Mechanical ventilation	68 (89.5)	88 (73.9)	6.298	0.012
PEEP (cmH2O), mean ± SD	8.4 ± 2.6	7.2 ± 2.1	3.468	0.001
FiO2 (%), mean ± SD	52.4 ± 18.2	42.8 ± 14.6	4.227	< 0.001
Circulatory support
Vasoactive drug use	60 (78.9)	70 (58.8)	7.941	0.005
Vasoactive drug duration (day), mean ± SD	8.6 ± 4.2	5.9 ± 3.1	4.873	< 0.001
Gastrointestinal therapy
Gastrointestinal motility drug use	68 (89.5)	70 (58.8)	19.586	< 0.001
Other therapies
Antibiotic therapy duration (day), mean ± SD	14.8 ± 6.2	11.2 ± 4.8	4.284	< 0.001
Continuous renal replacement therapy	32 (42.1)	31 (26.1)	5.259	0.022
Surgical intervention	28 (36.8)	31 (26.1)	2.472	0.116

PEEP: Positive end expiratory pressure.

Table 6 Comparison of complications between two groups, n (%)

Complications	Intolerance group (n = 76)	Tolerance group (n = 119)	Test statistic	P value
Infectious complications
Total incidence	50 (65.8)	51 (42.9)	9.644	0.002
Infected pancreatic necrosis	26 (34.2)	23 (19.3)	5.399	0.020
Abdominal infection	18 (23.7)	21 (17.6)	1.023	0.312
Bloodstream infection	22 (28.9)	18 (15.1)	5.330	0.021
Pulmonary infection	35 (46.1)	42 (35.3)	2.206	0.137
Non-infectious complications
Pancreatic fistula	16 (21.1)	16 (13.4)	1.943	0.164
Gastrointestinal bleeding	12 (15.8)	13 (10.9)	0.946	0.331
Thromboembolism	8 (10.5)	9 (7.6)	0.474	0.491
Nutrition-related complications
Aspiration	14 (18.4)	9 (7.6)	5.119	0.024
Electrolyte imbalance	40 (52.6)	38 (31.9)	7.668	0.006
Hyperglycemia	54 (71.1)	63 (52.9)	6.129	0.013

Table 7 Comparison of prognostic indicators between two groups, n (%)

Indicators	Intolerance group (n = 76)	Tolerance group (n = 119)	Test statistic	P value
Primary endpoint
28-day mortality	19 (25.0)	15 (12.6)	5.019	0.025
Secondary endpoints, mean ± SD
ICU length of stay (day)	18.6 ± 8.4	13.2 ± 6.1	4.989	< 0.001
Total hospital length of stay (day)	32.4 ± 12.8	25.7 ± 9.6	4.067	< 0.001

ICU: Intensive care unit.

Table 8 Multivariate logistic regression analysis of enteral nutrition intolerance

Variables	β	SE	Wald χ²	P value	OR	95%CI
APACHE II score	0.117	0.038	9.424	0.002	1.124	1.042-1.213
Serum albumin	-0.129	0.047	7.532	0.006	0.879	0.801-0.965
Intra-abdominal pressure	0.141	0.041	11.847	0.001	1.152	1.063-1.248
Constant	-0.268	1.824	0.022	0.882	0.765	-

Model goodness of fit: Hosmer-Lemeshow test P = 0.553; concordance index = 0.812 (95% confidence interval: 0.752-0.871); Bootstrap validation concordance index = 0.798 (95% confidence interval: 0.741-0.855). OR: Odds ratio; CI: Confidence interval; APACHE: Acute Physiology and Chronic Health Evaluation.

Table 9 Cox regression analysis of factors affecting 28-day mortality

Variables	β	SE	Wald χ²	P value	HR	95%CI
Enteral nutrition intolerance	0.771	0.333	5.366	0.020	2.164	1.127-4.156
APACHE II score	0.083	0.031	7.305	0.007	1.086	1.023-1.153
Number of organ failures	0.485	0.162	8.954	0.003	1.624	1.186-2.225

Cox regression model concordance index = 0.778 (95% confidence interval: 0.701-0.855); Bootstrap validation concordance index = 0.765 (95% confidence interval: 0.698-0.832); proportional hazards assumption test P = 0.276. HR: Hazard ratio; CI: Confidence interval; APACHE: Acute Physiology and Chronic Health Evaluation.