Nitrogen balance as a predictor of severe acute pancreatitis during early enteral feeding

The objective was to investigate the nitrogen balance (AB) in patients with acute pancreatitis who have predictors of severe course with early nasogastric and nasojejunal feeding and to assess it as a predictor of the severe form of the disease.

Materials and methods. A prospective cohort single-center study was carried out in the Intensive Care Unit (ICU) of the Occupational Health Facility “Neftyanik”, Tyumen. The participants in the study (n = 64) presenting predictors of severe acute pancreatitis (APACHE II > 8, CRP > 150 mg/L, SOFA > 2) received early enteral feeding (during the first 24 hrs.) via a nasogastric (NG) or nasojejunal (NJ) probe. The feeding formula (the standard polymer formula enriched with dietary fibers) was administered during the first 5 days taking into consideration its tolerability. Urinary nitrogen excretion was determined based on urinary urea and thereafter NB was calculated. Raw data were statistically processed using SPSS – 26 software suite.

Results. During early NJ feeding, patients received statistically significantly more nitrogen compared to the NG feeding. In severe AP patients, starting from day 3, negative NB was statistically significantly greater than in moderately severe AP patients. The NB-based severe acute pancreatitis prognosis models are statistically significant – day 3: AUC 0.785 (95 % CI: 0.670–0.900; p <0.001), sensitivity (Se) – 0.613, specificity (Sp) 0.909, cut-off value – 14.45 g/day; day 4: AUC – 0.768 (95 % CI 0.653–0.884; p = <0.001), cut-off value – 16.8 g/day, Se – 0.774 and Sp – 0.696; day 5: AUC – 0.903 (95 % CI 0.828–0.979; p = <0.001), cut-off value – 10.07 g/day, Se – 0.839, and Sp – 0.848. Inclusion of the additional index – the method of delivering enteral feeding: NG or NJ – into each of the formed one-factor models has not changed the results.

Conclusion. Starting from day 3 of the disease onset, daily nitrogen balance can be used as a predictor of a severe form of acute pancreatitis. The method of feeding (NG or NJ) rendered no influence on the prognosis model.

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