Clinical outcome in low socioeconomic patients with severe acute pancreatitis treated either with early nasogastric tube or total parenteral nutrition: a randomized controlled trial

Abstract

Background: Early nasogastric feeding has shown beneficial effect in the low socioeconomic group of patient with severe acute pancreatitis (SAP). The current randomized controlled study was performed to assess the effect of early nasogastric feeding as compared to total parenteral nutrition (TPN).Methods: Fifty patients admitted with diagnosis of SAP were randomly allocated to receive nnteral feeding (EF) (at the rate of 25 ml/hour and was gradually increased up to 100 ml/hr) or TPN within 24 hours of hospital admission. The nutritional regimen was aimed to be iso-caloric between the two groups. Patient’s demographics, hospital stay, nutrition, total cost, complication, and mortality were observed for 1 month in follow up.Results: All fifty patients were completed the study. Patient demographics were similar in both groups. 38/50 belonged to low socioeconomic status in the study group (Twenty in EF and eighteen in TPN group). The complications were significantly lower in EF group (pancreatic infection (11 vs. 4, p=0.037), central venous catheter infection (EF=0 vs. TPN=8, p=0.002), multiorgan failure (EF=5, TPN=12, p=0.037). Early recovery in EF group was significant with the mean duration of hospital stay of 6.76 days as compared to 10.4 days in the TPN group. The mean expenditure in the EF group was 1268 as compared to 13688 Indian rupees in the TPN group.Conclusions: This study shows that early EF improves early recovery, lower complications and cost effective measure in SAP especially in low socioeconomic group of patients.

Comparative assessment of severity and prognosis of acute pancreatitis through APACHE II and HAPS predictor models

“…20 However, Kumar et al in their study, similar to current study reported a dominance of gall stone disease (74%) over alcoholic etiology. 21 As such gall stone disease was observed to be the most common etiology reported in different published reports similar to present study.…”

“…20 In the study by Kumar et al mean duration of hospital stay was 6.98 days which is slightly higher than that in present study. 21 Lower duration of hospital stay in present study could be owing to the tertiary care status of our facility where most of the patients were referred from primary or secondary care facilities and duration of hospital stay mentioned in the study is only reflective of stay at reported facility.…”

“…Kumar et al also reported a dominance of conservative management, and reported surgical intervention for pancreatic necrosis in only 4% of cases. 21 Surgical options in acute pancreatitis are often limited as there is no single operative treatment for acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis.…”

“…18 Compared to published studies, the mortality rate in present study was higher. [20][21][22][23] The reason for this could be high proportion of patients with systemic complications, especially acute renal failure which is considered to be a significant predictor of mortality in acute pancreatitis patients. Moreover, the high proportion of patients from lower-socioeconomic class in present study could also be a possible reason for high mortality due to poor nutritional status which might have contributed towards a higher mortality.…”