Screening and risk factors of exocrine pancreatic insufficiency in critically ill adult patients receiving enteral nutrition

Abstract

IntroductionMalnutrition is a frequent problem associated with detrimental clinical outcomes in critically ill patients. To avoid malnutrition, most studies focus on the prevention of inadequate nutrition delivery, whereas little attention is paid to the potential role of exocrine pancreatic insufficiency (EPI). In this trial, we aim to evaluate the prevalence of EPI and identify its potential risk factors in critically ill adult patients without preexisting pancreatic diseases.MethodsIn this prospective cross-sectional study, we recruited 563 adult patients with critical illnesses. All details of the patients were documented, stool samples were collected three to five days following the initiation of enteral nutrition, and faecal elastase 1 (FE-1) concentrations were assayed using an enzyme-linked immunosorbent assay kit. Blood samples were also taken to determine serum amylase and lipase activity.ResultsThe percentages of recruited patients with EPI (FE-1 concentration <200 μg/g) and severe EPI (FE-1 concentration <100 μg/g) were 52.2% and 18.3%, respectively. The incidences of steatorrhea were significantly different (P < 0.05) among the patients without EPI, with moderate EPI (FE-1 concentration = 100 to 200 μg/g) and severe EPI (FE-1 concentration < 100 μg/g). Both multivariate logistic regression analysis and z-tests indicated that the occurrence of EPI was closely associated with shock, sepsis, diabetes, cardiac arrest, hyperlactacidemia, invasive mechanical ventilation and haemodialysis.ConclusionsMore than 50% of critically ill adult patients without primary pancreatic diseases had EPI, and nearly one-fifth of them had severe EPI. The risk factors for EPI included shock, sepsis, diabetes, cardiac arrest, hyperlactacidemia, invasive mechanical ventilation and haemodialysis.Trial registrationNCT01753024

Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients: a double-blind randomized trial

“…In addition to gastric emptying, the ability of the gut to digest and absorb the dietary provided protein is an important factor determining its efficacy, especially in critically ill patients where impairments in digestion and absorption of macronutrients have been shown [ 34 – 36 ]. The question arises whether the gut has sufficient capacity to digest higher amounts of protein.…”

Diarrhö auf der Intensivstation

“…Die hierdurch verursachte pankreatogene bzw. chologene Diarrhö ist eng mit Schock, Sepsis, Herz-Kreislauf-Stillstand, Hyperlaktatämie, invasiver Beatmung und Hämodialyse assoziiert und sistiert rasch nach Gabe von Pankreasenzymen oder Cholestyramin [28,29].…”

How Much and What Type of Protein Should a Critically Ill Patient Receive?

“…In addition, there is growing evidence that there may be a limit to the amount of protein that even a normal GI tract can digest and that protein given in excess of this amount would be lost in the feces. Thus, in the future, it will be important to identify the patient populations that have a compromised GI tract and the amount of protein that can be delivered and absorbed by a given patient 20 The extracellular amino acid pool.…”