Computed tomography-derived nasojejunal tube tip-to-gastric antrum path length and short-term outcomes in severe acute pancreatitis

Table 1 Baseline and clinical characteristics according to exploratory short-term outcome, n (%)

Characteristic	Favorable outcome (n = 46)	Poor outcome (n = 17)	P value
Sex	-	-	0.461
Male	25 (54.3)	11 (64.7)	-
Female	21 (45.7)	6 (35.3)	-
Age, years	45.5 (38.3-56.5)	55.0 (35.0-83.0)	0.230
Etiology	-	-	0.058
Hyperlipidemic	32 (69.6)	7 (41.2)	-
Biliary	3 (6.5)	4 (23.5)	-
Other	11 (23.9)	6 (35.3)	-
APACHE II score	12.0 (10.0-17.0)	19.0 (16.0-22.0)	< 0.001
Ranson pancreatitis score	3.0 (2.0-4.0)	4.0 (3.0-5.0)	0.024
Time to initiation of enteral nutrition, hour	41.0 (35.0-55.8)	68.0 (43.0-93.0)	0.004
Time from EN initiation to enteral nutrition target, hour	94.0 (48.8-142.8)	56.0 (44.0-100.0)	0.127
CT-derived curved antrum-to-NJ-tip path length, cm	17.2 (14.0-22.0)	19.3 (15.2-22.7)	0.382
Mechanical ventilation	-	-	0.005
Yes	12 (26.1)	11 (64.7)	-
No	34 (73.9)	6 (35.3)	-

Continuous variables are presented as median (interquartile range) and were compared using the Mann-Whitney U test. Etiology was compared using the Fisher-Freeman-Halton exact test. Favorable outcome: Intensive care unit length of stay ≤10 days without treatment failure (n = 46). Poor outcome: Intensive care unit length of stay >10 days or treatment failure (n = 17). APACHE II: Acute Physiology and Chronic Health Evaluation II; NJ: Nasojejunal; EN: Enteral nutrition; CT: Computed tomography.

Table 2 Overall intensive care unit nutritional, and temporal characteristics, n (%)

Outcome/timing variable	Overall cohort (n = 63)
ICU length of stay, day	7.0 (5.0-10.0); range 20-31.0
Post-CT ICU length of stay, day	7.0 (5.0-10.0); range 20-31.0
Mechanical ventilation	23 (36.5)
Mechanical ventilation duration among ventilated patients, hour	105.0 (82.0-201.0)
NJ placement after ICU admission, hour	7.0 (5.0-10.0)
CT after NJ placement, hour	5.0 (4.0-7.0)
CT after ICU admission, hour	12.0 (9.0-17.0)
EN initiation after ICU admission, hour	46.0 (36.5-68.0)
Time from EN initiation to target ≥ 20 kcal/kg/day, hour	86.0 (48.0-135.0)
CT performed before EN initiation	63 (100.0)
Treatment failure	4 (6.3)
ICU death	1 (1.6)
Infected pancreatic necrosis requiring surgery/intervention	2 (3.2)
New renal replacement therapy	1 (1.6)
Exploratory poor composite outcome	17 (27.0)
ICU LOS > 10 days	15 (23.8)

Continuous variables are median (interquartile range), with range shown for intensive care unit length of stay. Treatment-failure components are mutually summarized by the primary qualifying event. ICU: Intensive care unit; CT: Computed tomography; NJ: Nasojejunal; EN: Enteral nutrition; CRRT: Continuous renal replacement therapy; LOS: Length of stay.

Table 3 Association of computed tomography-derived path length with continuous intensive care unit outcomes

Analysis	Outcome	Variable	Effect estimate	95%CI	P value
Unadjusted Spearman correlation	Total ICU length of stay, day	CT-derived curved path length	ρ = 0.055	-0.216 to 0.317	0.671
Unadjusted Spearman correlation	Post-CT ICU length of stay, day	CT-derived curved path length	ρ = 0.053	-0.218 to 0.315	0.682
Unadjusted Spearman correlation	Mechanical ventilation duration, hour	CT-derived curved path length	ρ = 0.064	-0.399 to 0.509	0.771
Adjusted median regression	Total ICU length of stay, day	CT-derived curved path length, per 5-cm increase	0.192 days	-0.922 to 1.305	0.732
Adjusted median regression	Total ICU length of stay, day	APACHE II, per 1-point increase	0.275 days	0.082 to 0.468	0.006
Adjusted median regression	Post-CT ICU length of stay, day	CT-derived curved path length, per 5-cm increase	0.192 days	-0.914 to 1.298	0.730
Adjusted median regression	Post-CT ICU length of stay, day	APACHE II, per 1-point increase	0.275 days	0.084 to 0.467	0.006

Effect estimates for Spearman-correlation rows are Spearman ρ and are dimensionless; effect estimates for median-regression rows are adjusted median differences in intensive care unit days. Spearman 95% confidence intervals were obtained by 10000 bootstrap resamples. Median regression included computed tomography-derived curved path length and Acute Physiology and Chronic Health Evaluation II. CT: Computed tomography; ICU: Intensive care unit; APACHE II: Acute Physiology and Chronic Health Evaluation II; CI: Confidence interval.

Table 4 Firth penalized logistic regression for the exploratory short-term composite outcome

Model	Variable	Adjusted OR	95%CI	P value	Events/predictor parameters
1	CT-derived curved path length, per 5-cm increase	1.343	0.808-2.232	0.255	17/2
1	APACHE II, per 1-point increase	1.177	1.053-1.315	0.004	17/2
2	CT-derived curved path length, per 5-cm increase	1.423	0.826-2.451	0.204	17/3
2	APACHE II, per 1-point increase	1.154	1.026-1.297	0.017	17/3
2	EN initiation, per 24-hour delay	1.816	1.036-3.182	0.037	17/3

Model 1 included nasojejunal tube path length and Acute Physiology and Chronic Health Evaluation II score. Model 2 additionally included time to initiation of enteral nutrition and was considered exploratory. The binary outcome comprised 17 poor composite events. Model 1 contained two predictor parameters (approximately 8.5 events per parameter), and model 2 contained three predictor parameters (approximately 5.7 events per parameter). Wald 95% confidence intervals are reported. OR: Odds ratio; CT: Computed tomography; APACHE II: Acute Physiology and Chronic Health Evaluation II; CI: Confidence interval; EN: Enteral nutrition.