title: Timing of enteral nutrition in acute pancreatitis: meta-analysis of individuals using a single-arm of randomised trials.
abstract: BACKGROUND
  In acute pancreatitis, enteral nutrition (EN) reduces the rate of complications, such as infected pancreatic necrosis, organ failure, and mortality, as compared to parenteral nutrition (PN). Starting EN within 24 h of admission might further reduce complications.
  
  
  METHODS
  A literature search for trials of EN in acute pancreatitis was performed. Authors of eligible trials were requested to provide the data of all patients in the EN-arm of their trials. A meta-analysis of individual patient data was performed. The cohort of patients with EN was divided into patients receiving EN within 24 h or after 24 h of admission. Multivariable logistic regression, adjusting for predicted disease severity and trial, was used to study the effect of timing of EN on a composite endpoint of infected pancreatic necrosis, organ failure, or mortality.
  
  
  RESULTS
  Observational data from 165 individuals from 8 randomised trials were obtained; 100 patients with EN within 24 h and 65 patients with EN after 24 h of admission. In the multivariable model, EN started within 24 h of admission compared to EN started after 24 h of admission, reduced the composite endpoint from 45% to 19% (adjusted odds ratio [OR] of 0.44; 95% confidence interval [CI] 0.20-0.96). Within the composite endpoint, organ failure was reduced from 42% to 16% (adjusted OR 0.42; 95% CI 0.19-0.94).
  
  
  CONCLUSIONS
  In this meta-analysis of observational data from individuals with acute pancreatitis, starting EN within 24 h after hospital admission, compared with after 24 h, was associated with a reduction in complications.
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: o.j.bakker@pancreatitis.nl.
authors.forename: Olaf J
authors.initials: OJ
authors.lastname: Bakker
authors.affiliation: Dept. of Operation Theatres and Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Brunschot
authors.affiliation: Dept. of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Farre
authors.affiliation: Dept. of Surgery, Southampton General Hospital, University of Southampton, UK.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Johnson
authors.affiliation: Dept. of Surgery, Nutritional and Metabolic Unit, University of Patras, Patras, Greece.
authors.forename: Fotis
authors.initials: F
authors.lastname: Kalfarentzos
authors.affiliation: Dept. of Thoracic Surgery, Swedish Cancer Instititute and Medical Center, Seattle, WA, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
authors.affiliation: Dept. of Surgery, Petz Aladár Teaching Hospital, Györ, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Oláh
authors.affiliation: Physicians Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh, PA, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: O'Keefe
authors.affiliation: Dept. of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
authors.affiliation: Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: James J
authors.initials: JJ
authors.lastname: Powell
authors.affiliation: Dept. of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Dept. of Operation Theatres and Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Maroeska M
authors.initials: MM
authors.lastname: Rovers
authors.affiliation: Dept. of Operation Theatres and Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
mesh_terms: D000208:Acute Disease; D004750:Enteral Nutrition / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute pancreatitis; Enteral nutrition; Infected necrosis; Meta-analysis; Necrosis; Organ failure