Early EN within 24 hours of admission is safe and provides benefits for predicted severe or SAP, but not for mild to moderate pancreatitis.
Objectives: It is still not clear what influences hemoglobin has on the outcomes of patients with sepsis. The intention of this research is to investigate the impact of early hemoglobin levels on clinical outcomes for sepsis. Methods: In this single-center, cohort study, each patient was put into one of four groups dependent on hemoglobin levels of 70 g/L, 80 g/L, or 90 g/L in the first 48 h of being admitted to intensive care unit (ICU). Adjustments for baseline/confounding factors were made using the multiple Cox regression model. Results: In all, 235 septic patients were examined in this research. The non-survivors exhibited significantly higher levels for early hemoglobin status at or below 80 g/L (33.7% vs. 19.4%, P = 0.016) than survivors. Survival curve demonstrated that septic patients with early hemoglobin levels at or below 80 g/L survived at significantly lower rates than those with hemoglobin above 80 g/L. Multivariate Cox analysis demonstrated that levels of 1-year mortality rose as early hemoglobin levels fell in the first 48 h after ICU admission, with relative risks for 80 g/L to 90 g/L, 70 g/L to 80 g/L, and at or below 70 g/L being respectively 1.11 (95% CI: 0.654–1.882), 1.742 (95% CI: 0.969–3.133), 1.981 (95% CI: 1.124–3.492) times higher than those for hemoglobin levels above 90 g/L. Conclusions: Hemoglobin levels at or below 80 g/L in the first 48 h after ICU admission are an alternative indicator for predicting long-term mortality of sepsis. Awareness should be encouraged of the importance of targeting early hemoglobin levels when treating sepsis to improve prognosis.
Objective: Although hyperbilirubinemia has been associated with mortality in patients who are critically ill, yet no clinical studies dissect the effect of dynamic change of hyperbilirubinemia on long-term septic prognosis. The study aims to investigate the specific stages of hyperbilirubinemia and potential risk factors on long-term outcomes in patients with sepsis.Methods: In this retrospective observational cohort study, patients with sepsis, without previous chronic liver diseases, were identified from the Medical Information Mart for the Intensive Care III MIMIC-III database. We used propensity scores (PS) to adjust the baseline differences in septic patients with hyperbilirubinemia or not. The multivariate Cox was employed to investigate the predictors that influence a clinical outcome in sepsis.Results: Of 2,784 patients with sepsis, hyperbilirubinemia occurred in 544 patients (19.5%). After PS matching, a survival curve demonstrated that patients with sepsis with the new onset of total bilirubin (TBIL) levels more than or equal to 5 mg/dl survived at significantly lower rates than those with TBIL levels <5 mg/dl. Multivariate Cox hazard analysis showed that patients with TBIL at more than or equal to 5 mg/dl during sepsis exhibit 1.608 times (95% CI: 1.228–2.106) higher risk of 1-year mortality than those with TBIL levels <5 mg/dl. Also, age above 65 years old, preexisting malignancy, a respiratory rate above 30 beats/min at admission, serum parameters levels within 24-h admission, containing international normalized ratio (INR) above 1.5, platelet <50*10∧9/L, lactate above 4 mmol/L, and bicarbonate <22 or above 29 mmol/L are the independent risk factors for long-term mortality of patients with sepsis.Conclusions: After PS matching, serum TBIL levels at more than or equal to 5 mg/dl during hospitality are associated with increased long-term mortality for patients with sepsis. This study may provide clinicians with some cutoff values for early intervention, which may improve the prognosis of patients with sepsis.
We appreciate the careful reading of our article by Dijk and Bakker. The inclusion and exclusion criteria in our study are carefully defined. Therefore, we insist that the results of our current study are indisputable. There are a few points that need to be addressed.First, our study is focused on whether enteral nutrition (EN) initiated within 24 hours of admission could bring benefits in different severities of acute pancreatitis (AP). One of inclusion criteria in our study is according to the timing of EN initiation within 24 hours of admission in AP, regardless of the nutrition form in the controlled group (parenteral nutrition (PN) or EN after 24 hours of admission). On the basis of our study methodology, it is credible to conclude that early EN within 24 hours seems to be beneficial in predicted severe acute pancreatitis (pSAP) or severe acute pancreatitis (SAP) by significantly decreasing the risk of multiple organ failure and pancreatic infections compared with PN or EN outside of 24 hours. Furthermore, in our limitations, we discussed the point that different feeding routes of EN and control groups in the trials may have influenced the data correction, and only 3 trials controlled with late EN. However, 2 of the studies showed that early EN within 24 hours seems not to be beneficial for AP, 1,2 in accordance with our conclusion. Bakker has suggested that compared with late EN, early EN within 24 hours provided no benefit for patients with AP, but the data seem show beneficial clinical outcomes in pSAP or SAP. 3 We would like to thank Dijk and Bakker for their kind and professional proposals on our methodology. However, according to the explanation above, we insist on the conclusions that early EN within 24 hours seems to be beneficial in pSAP or SAP by significantly decreasing the risk of multiple organ failure and pancreatic infections compared with PN or EN outside of 24 hours. References1. Stimac D, Poropat G, Hauser G, et al. Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis: a randomized clinical trial. Pancreatology. 2016;16:523-528. 2. Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Dig Surg. 2006;23:336-344, 344-345. 3. Bakker OJ, van Brunschot S, van Santvoort HC, et al. Early versus ondemand nasoenteric tube feeding in acute pancreatitis. N Engl J Med.
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