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Enteral Nutrition Preparations for Blood Glucose Variability and Prognosis for Severe Acute Pancreatitis With Stress Hyperglycemia.

Context
Severe acute pancreatitis (SAP) is a common critical illness, and stress hyperglycemia is the greatest independent risk factor for poor prognoses in critically ill patients. Enteral nutrition can not only provide an essential energy source for the body and improve a patient's intestinal micro-ecology but also can play a critical role in blood glucose management, especially for blood glucose variability.


Objective
The study intended to investigate the effects of different enteral nutrition preparations, including a slow-release starch, on blood glucose variability, nutritional status, inflammatory indexes, and prognosis for patients with SAP with stress hyperglycemia.


Design
The research team designed a retrospective analysis of SAP patients' data.


Setting
The study took place in the Department of Critical Care Medicine at Ruijin Hospital of the Shanghai Jiao Tong University School of Medicine in Shanghai, China.


Participants
Participants were 129 SAP patients with stress hyperglycemia, who had a random blood glucose of ≥11.1 mmol/L and who had been admitted to the department at the hospital between January 2013 and December 2018.


Intervention
After the recovery of intestinal function, Patients were inserted a nasointestinal feeding tube below the ligament of Treitz to deliver enteral nutrition. According to the presence or absence of enteral nutrition preparations containing slow-release starch in the nutritional therapy, the research team divided patients into an intervention group (n = 63) that received a protein-based, enteral nutrition preparation containing slow-release starch and a control group (n = 66) that received a protein- or short-peptide-based, enteral nutrition preparation containing no slow-release starch.


Outcome Measures
Postintervention for both groups, the research team measured the total amount of insulin used. At baseline and postintervention, the team measured for both groups: (1) the blood glucose variability: the average value of blood glucose (GLU AVE), standard deviation of blood glucose (GLU SD), coefficient of variation of blood glucose (GLU CV), large amplitude of glycemic excursions (GLU LAGE), and nutrition indicators-serum albumin (ALB), serum pre-albumin (PA), serum total protein (TP), and hemoglobin (HB); (2) the inflammatory markers: total amount of white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT); and (3) prognostic indicators: the length of ICU stay, total length of hospital stay, and 60-day and 90-day mortality.


Results
The intervention group used significantly less insulin than the control group did, at 12.23 ± 6.74 and 35.31 ± 12.79 IU/d, respectively (P ≤ .05). Postintervention for 2 weeks, the blood glucose variability in the intervention group showed a decline. Between baseline and postintervention, the following significant decreases in blood glucose variability occurred for the group (P ≤ .05): (1) the GLU AVE from 14.27 ± 2.27 to 10.84 ± 1.97, (2) the GLU SD from 2.76 ± 1.48 to 2.15 ± 0.88, (3) the GLU CV from 20.1 ± 8.93 to 16.2 ± 3.61, and (4) the GLU LAGE from 7.9 ± 4.3 to 6.2 ± 2.5. Between baseline and postintervention, the following significant increases in blood glucose variability occurred for the control group (P ≤ .05): (1) the GLU AVE from 11.2 ± 2.3 to 12.1 ± 1.9, (2) the GLU SD from 1.9 ± 1.09 to 3.2 ± 1.0, (3) the GLU CV from 16.2 ± 6.2 to 19.6 ± 7.8, and (4) the GLU LAGE from 4.6 ± 2.6 to 5.0 ± 2.6. Postintervention, the GLU AVE, GLU SD, and GLU CV in the intervention group were significantly lower than those in the control group (p≤0.05). For nutritional indicators, the levels of ALB, PA, and TP in both groups significantly increased between baseline and postintervention (P ≤ .05), but HB didn't increase. However, no statistically significant differences existed between the groups (P > .05). For inflammatory markers, the total WBCs, CRP, and PCT in both groups significantly declined between baseline and postintervention (P ≤ .05). However, the decline in CRP in the intervention group was greater, from 154.5 ± 64.8 to 8.4 ± 6.8, than that of the control group, from 155.2 ± 88.4 to 15.6 ± 13.4, but no statistically significant differences existed between the groups (P > .05). The length of ICU stay and total length of hospital stay in the intervention group, from 53.9 ± 5.21 d and 74.7 ± 9.18 d, respectively, were significantly shorter than those in the control group, at 25.9 ± 4.89 and 43.6 ± 7.98 , respectively (P ≤ .05). The 60-day and 90-day mortality in the intervention group were significantly lower than those in the control group, at 0% and 0% compared to 2.8% and 6.9%, respectively (P ≤ .05).


Conclusions
The application of enteral nutrition preparation containing sustained-release starch in treatment of SAP patients with stress hyperglycemia, may increase nutrition indicators quickly, significantly reduce blood glucose variability, improve inflammatory markers, shorten the length of ICU stay and hospital stay, and decrease the mortality.