Meta-analysis of risk factors for enteral nutritional feeding intolerance in Chinese patients with severe acute pancreatitis

Background: The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. Methods: This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. Results: Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; p = 0.03) and complications (OR: 0.48; p = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; p = 0.24), mortality (OR: 0.69; p = 0.17), extrapancreatic infection (OR: 0.64, p = 0.54), pulmonary infection (OR: 1.23; p = 0.69), blood infection (OR: 0.60; p = 0.35), urinary tract infection (OR: 0.97; p = 0.97), pancreatic pseudocyst (OR: 0.59; p = 0.28), fluid collection (OR: 0.91; p = 0.76), organ failure (OR: 0.63; p = 0.19), acute respiratory distress syndrome (OR: 0.80; p = 0.61), surgical intervention (OR: 0.97; p = 0.93), dialysis (OR: 2.34; p = 0.57), use of respirator or ventilator (OR: 1.90; p = 0.40), intensive care unit treatment (OR: 2.97; p = 0.18), and additional antibiotics (OR: 0.59; p = 0.28) between the experimental and control groups. Conclusions: It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

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Systematic review and meta-analysis of the safety and effectiveness of low molecular heparin for severe acute pancreatitis

Annals of Palliative Medicine ◽

10.21037/apm-21-3058 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Hui Wang ◽

Ying Xu ◽

Meijuan Yang ◽

Dexing Zheng ◽

Lijiao Chen

Keyword(s):

Systematic Review ◽

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Meta Analysis

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Minimally invasive drainage versus open surgical debridement in SAP/SMAP – a network meta-analysis

BMC Gastroenterology ◽

10.1186/s12876-019-1078-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Kai Zhang ◽

Xiaole Zhu ◽

Chaoqun Hou ◽

Chenyuan Shi ◽

Yi Miao ◽

...

Keyword(s):

Acute Pancreatitis ◽

Minimally Invasive ◽

Severe Acute Pancreatitis ◽

Meta Analysis ◽

Multiple Organ ◽

Surgical Debridement ◽

Percutaneous Catheter Drainage ◽

Endoscopic Drainage ◽

Percutaneous Catheter ◽

Study Participants

Abstract Background The efficacy of some therapeutic methods (open surgical debridement (OSD), conservative treatment (CST) and minimally invasive drainage (MID)) for severe acute pancreatitis (SAP) and moderately severe acute pancreatitis (MSAP) has been widely evaluated. However, the results remained controversial. We performed this study to illuminate whether any difference in incidence exists on patients with SAP/MSAP treated with OSD and MID. Methods Eligible articles were collected base of a comprehensive review of PUBMED, EMBASE, COCHRANE, CKNI and WANGFANG for published randomized controlled trials. Two steps of meta-analysis were performed, routine pair-wise meta-analysis and network meta-analysis. Results Thirteen studies were included in this study. Participants were classed as 5 groups, CST, early MID (EMID), late MID (LMID), early OSD (EOSD) and late OSD (LOSD). And MID contains endoscopic drainage (ESD), percutaneous catheter drainage (PCD) and minimally invasive surgery (MIS). Compared with CST, MID could decrease both mortality and multiple organ dysfunction syndrome (MODS) rate but OSD couldn’t. Both EMID and MID can significantly decrease the mortality and MODS rate compared to CST. PCD might be most likely to have a benefit compared to CST. Conclusion Existing evidence for the use of MID in SAP/MSAP is reliable and it can be used as early treatment. OSD, if necessary, should be avoided or delayed as long as possible.

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Fatty Liver Disease and Non-Alcoholic Fatty Liver Disease Worsen the Outcome in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9092698 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2698

Author(s):

Szilárd Váncsa ◽

Dávid Németh ◽

Péter Hegyi ◽

Zsolt Szakács ◽

Péter Jeno Hegyi ◽

...

Keyword(s):

Risk Factors ◽

Acute Pancreatitis ◽

Liver Disease ◽

Fatty Liver ◽

Hospital Stay ◽

Fatty Liver Disease ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

The prevalence of fatty liver disease (FLD) and that of non-alcoholic fatty liver disease (NAFLD) share some risk factors known to exacerbate the course of acute pancreatitis (AP). This meta-analysis aimed to investigate whether FLD or NAFLD carry a higher risk of untoward outcomes in AP. In accordance with PRISMA guidelines, we performed a systematic search in seven medical databases for cohort studies that compared the outcomes of AP for the presence of FLD or NAFLD, and we calculated pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI). We included 13 articles in our meta-analysis. AP patients with FLD were more likely to die (5.09% vs 1.89%, OR = 3.56, CI = 1.75–7.22), develop severe AP (16.33% vs 7.87%, OR = 2.67, CI = 2.01–3.56), necrotizing pancreatitis (34.83% vs 15.75%, OR = 3.08, CI = 2.44–3.90) and had longer in-hospital stay (10.8 vs 9.2 days, WMD = 1.46, OR = 0.54–2.39). Patients with NAFLD were more likely to have severe AP and longer hospital stay. Both FLD and NAFLD proved to be independent risk factors of a more severe disease course (OR = 3.68, CI = 2.16–6.29 and OR = 3.39, CI = 1.52–7.56 for moderate/ severe vs. mild AP, respectively). FLD and NAFLD worsen the outcomes of AP, which suggests that incorporating FLD or NAFLD into prognostic scoring systems of AP outcomes might improve the prediction of severity and contribute to a more individualized patient care.

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Ringer’s Lactate Prevents Early Organ Failure by Providing Extracellular Calcium

Journal of Clinical Medicine ◽

10.3390/jcm9010263 ◽

2020 ◽

Vol 9 (1) ◽

pp. 263 ◽

Cited By ~ 4

Author(s):

Biswajit Khatua ◽

Jordan R. Yaron ◽

Bara El-Kurdi ◽

Sergiy Kostenko ◽

Georgios I. Papachristou ◽

...

Keyword(s):

Acute Pancreatitis ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Systemic Inflammation ◽

Normal Saline ◽

Meta Analysis ◽

Extracellular Calcium ◽

Severe Pancreatitis ◽

Ringer’S Lactate

Objective: Ringer’s lactate may improve early systemic inflammation during critical illnesses like severe acute pancreatitis, which are associated with hypocalcemia. Ringer’s lactate is buffered and contains lactate and calcium. We, thus analyzed extracellular calcium or lactate’s effects on the mechanisms, intermediary markers, and organ failure in models mimicking human disease with nonesterified fatty acid (NEFA) elevation. Methods: Meta-analyses and experimental studies were performed. Experimentally, extracellular calcium and lactate were compared in their interaction with linoleic acid (LA; a NEFA increased in human severe pancreatitis), and its subsequent effects on mitochondrial depolarization and cytosolic calcium signaling resulting in cell injury. In vivo, the effect of LA was studied on organ failure, along with the effect of calcium or lactate (pH 7.4) on severe acute pancreatitis-associated organ failure. A meta-analysis of human randomized control trials comparing Ringer’s lactate to normal saline was done, focusing on necrosis and organ failure. Results: Calcium reacted ionically with LA and reduced lipotoxic necrosis. In vivo, LA induced organ failure and hypocalcemia. During severe pancreatitis, calcium supplementation in saline pH 7.4, unlike lactate, prevented hypocalcemia, increased NEFA saponification, reduced circulating NEFA and C-reactive protein, reduced pancreatic necrosis adjacent to fat necrosis, and normalized shock (carotid pulse distension) and blood urea nitrogen elevation on day 1. This, however, did not prevent the later increase in serum NEFA which caused delayed organ failure. Meta-analysis showed Ringer’s lactate reduced necrosis, but not organ failure, compared with normal saline. Conclusion: Hypocalcemia occurs due to excess NEFA binding calcium during a critical illness. Ringer’s lactate’s early benefits in systemic inflammation are by the calcium it provides reacting ionically with NEFA. This, however, does not prevent later organ failure from sustained NEFA generation. Future studies comparing calcium supplemented saline resuscitation to Ringer’s lactate may provide insights to this pathophysiology.

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