Establishment of a predictive nomogram model for enteral nutrition feeding intolerance in patients with severe acute pancreatitis

Abstract

Objective \nTo establish a individualized predictive nomogram model for enteral nutrition feeding intolerance (ENFI) by analyzing the risk factors of ENFI in patients with severe acute pancreatitis (SAP) . \n \n \nMethods \nThe clinical data of 188 SAP patients hospitalized in Shandong Provincial Hospital Affiliated to Shandong University from January 2015 to December 2017 were retrospectively collected by objective sampling. Univariate and multivariate Logistic regression analysis were used to identify the independent risk factors of ENFI. R software was used to establish a predictive nomogram model. Bootstrap method was used to validate the nomogram model and ROC curve was used to explore the predictive efficacy of the model in predicting the ENFI. \n \n \nResults \nA total of 49 cases out of 118 SAP patients developed ENFI, with an incidence of 41.5%. The result of Logistic regression analysis showed that the independent risk factors of ENFI in SAP patients were age≥70 years old (OR=1.377, 95%CI: 1.088-1.743) , fasting blood glucose≥11.0 mmol/L (OR=3.222, 95%CI: 1.545-6.719) , enteral nutrition starting time≥72 h (OR=3.800, 95%CI: 1.541-9.370) , no dietary fiber added (OR=7.419, 95%CI: 2.651-20.760) and intra-abdominal pressure≥15 mmHg (OR=3.881, 95%CI: 1.735-8.679) (P<0.05) . The nomogram model showed that the consistency index for predicting the risk of ENFI in SAP patients was 0.869, while ROC curve showed that the area under the curve for the nomogram model predicting ENFI was 0.857 (95%CI: 0.779-0.931) . \n \n \nConclusions \nThe independent risk factors of ENFI in SAP patients are age≥70 years old, fasting blood glucose≥11.0 mmol/L, enteral nutrition starting time≥72 h, no dietary fiber added and intra-abdominal pressure ≥15 mmHg. The nomogram established in this study can predict the risk of ENFI in SAP patients with good discrimination and accuracy, which could be used for predicting individual ENFI in SAP patients. \n \n \nKey words: \nPancreatitis;\xa0Nutrition support;\xa0Nomograms;\xa0Enteral nutrition;\xa0Feeding intolerance;\xa0Risk incidence