Therapeutic Effect of Perioperative Mild Hypothermia on Postoperative Neurological Outcomes in Patients with Acute Stanford Type A Aortic Dissection.

BACKGROUND: Postoperative patients of acute Stanford type A aortic dissection (AAAD) often experience complications consisting of nervous system injury. Mild hypothermia therapy has been proven to provide the therapeutic effect of cerebral protection. We aimed to investigate the therapeutic effects of perioperative mild hypothermia on postoperative neurological outcomes in patients with AAAD. METHODS: A prospective randomized controlled study was conducted on adult patients undergoing aortic dissection surgery between February 2017 and December 2017. Patients in the treatment group underwent mild hypothermia (34° to 35°C) immediately after surgery, and in the conventional therapy group, patients were rewarmed to normal body temperature (36° to 37°C). Postoperative time to regain consciousness, postoperative serum neuron-specific enolase (NSE) and S-100ß levels, cerebral tissue oxygen saturation, presence of delirium or permanent neurological dysfunction, intensive care unit (ICU) and hospital stay duration, and 28-day mortality were compared. RESULTS: We enrolled 55 patients who underwent AAAD surgery and were randomly allocated into to 2 groups, 27 patients in the treatment group and 28 patients in the conventional therapy group. Compared with the conventional therapy group, postoperative time to regain consciousness was much shorter for patients in the mild hypothermia group (12.65 hours, interquartile range [IQR] 8.28 to 23.82, versus 25.80 hours, IQR 14.00 to 59.80; P = .02), and the rate of regaining consciousness in 24 hours after surgery was much higher (74.07% versus 46.42%; P = .037). At the same time, the ICU stay of patients in the mild hypothermia therapy group was significantly shorter than that in the conventional therapy group (5.53 ± 3.13 versus 9.35 ± 8.76 days; P = .038). Cerebral tissue oxygen saturation, incidence of delirium or permanent neurological dysfunction, duration of hospital stay, and 28-day mortality showed no statistical difference. Postoperative serum NSE and S-100ß levels increased compared with preoperative baseline values in both groups (P < .05), and the serum NSE levels of patients in the mild hypothermia therapy was significantly lower than the conventional therapy group 1 hour (P = .049) and 6 hours (P = .04) after surgery. There was no difference in the chest drainage volume or shivering between the 2 groups 24 hours after surgery. CONCLUSIONS: Perioperative mild hypothermia therapy is able to significantly reduce brain cell injury and shorten the postoperative time to regain consciousness, thus improving the neurological prognosis of patients with AAAD.

[Effect of Xuebijing injection treatment on acute respiratory distress syndrome: a multicenter prospective randomized control clinical trial].

OBJECTIVE: To assess the therapeutic effect of Xuebijing injection on adult patients with acute respiratory distress syndrome (ARDS). METHODS: A multicenter prospective randomized control study was conducted at 10 intensive care units in Jiangsu province. A total of 172 early ARDS patients were randomly divided into Xuebijing treatment and control groups. All patients received routine therapy of ARDS while additional Xuebijing injection 100 ml was administered in the treatment group intravenously for 7 days. Lung injury score, acute physiology and chronic health evaluation II (APACHE II) score, multiple organ dysfunction score (MODS) and PaO2/FiO2 of the patients was recorded before and after treatment. Mortality at 28 days and the duration of mechanical ventilation were compared between two groups. RESULTS: Ninety-one patients were assigned to receive Xuebijing injection and 81 patients as control; Mortality at Days 28 and 90, the duration of mechanical ventilation and ventilation free days showed no difference between two groups (P > 0.05). PaO2/FiO2 improved after randomization versus pre-treatment in all patients. There was no significant difference between two groups. Murray scores were not significantly different between two groups. In a subgroup analysis of patients with pulmonary infection, pulmonary contusion and extra-pulmonary cause, two groups had no difference in mortality at Day 28, mortality at Day 90, the duration of mechanical ventilation, ventilation free days and days of ICU stay (P > 0.05). CONCLUSION: The treatment of Xuebijing injection early in course of ARDS does not improve the mortality of ARDS patients. But it may improve lung function and oxygenation. Further studies are warranted.

Integrin αEß7 is involved in the intestinal barrier injury of sepsis.

BACKGROUND: IL-9-producing CD4(+) T (Th9) cell was related to acute intestinal barrier injury in sepsis. Integrin αEß7 was an important lymphocyte homing receptor on the surface of intestinal Th9 cells. However, the roles of αEß7 in the intestinal injury caused by Th9 cells were not clear in sepsis. METHODS: To investigate the roles of αEß7 in the intestinal injury caused by Th9 cells in sepsis model, the Th9 cells percentages, αEß7, E-cadherin, IL-9, and D-lactate levels in both serum and intestinal tissue were measured. The intestinal histopathology, epithelium apoptosis, and mucosal permeability measurement were also performed. The survival rate of septic rats was recorded daily for 14 days. RESULTS: Rats were assigned to four cohorts: control cohort, sepsis cohort, sepsis+αEß7i (αEß7 inhibition) cohort, and sepsis+αEß7e (αEß7 overexpression) cohort. The Th9 cells percentages, αEß7, IL-9, and D-lactate levels of the sepsis cohort were significantly higher than those of the control cohort. The levels of these variables were also elevated progressively in the sepsis+αEß7i cohort, sepsis cohort, and sepsis+αEß7e cohort. The E-cadherin levels were decreased progressively in the control cohort, sepsis+αEß7i cohort, sepsis cohort, and sepsis+αEß7e cohort. Moreover, αEß7 overexpression could decrease the 14-day survival rate. The findings of histopathology staining, apoptosis detection, and intestinal permeability test also confirmed that the barrier injury was deteriorated or relieved by elevating or decreasing the αEß7 expression levels, respectively. CONCLUSIONS: Integrin αEß7 was closely associated with the intestinal barrier injury caused by Th9 lymphocytes in sepsis.

Risk factors and long-term prognosis for postoperative hypoxemia in patients with acute type A aortic dissection: A retrospective observational study.

Hypoxemia is 1 of the most common complications in the patients with acute Type A aortic dissection (ATAAD). This study aimed to summarize the risk factors, management strategies and long-term prognosis for postoperative hypoxemia in ATAAD patients. Baseline characteristics and clinical data of all the patients were collected. Patients were divided into 2 groups according to the PaO2/FiO2 after surgery: Hypoxemia group (n = 142) and Non-hypoxemia group (n = 68). The differences in gender, age, body mass index, operation time, cardiopulmonary bypass (CPB) time, aortic cross-clamping time, deep hypothermic circulatory arrest time, preoperative PaO2/FiO2, postoperative PaO2/FiO2, PaO2/FiO2 before extubating, time of mechanical ventilation, length of intensive care unit stay, length of hospital stay, in-hospital mortality, and overall mortality were compared between the 2 groups. The incidence of postoperative hypoxemia in this study was 67.6% (142/210). body mass index (26.4 ±â€…3.8 vs 24.4 ±â€…3.3kg/m2, P < .001) in the hypoxemia group were markedly higher and CPB time (196.3 ±â€…41.0 vs 181.0 ±â€…37.3 minutes, P = .010) in the hypoxemia group were significantly longer than those in the non-hypoxemia group. While preoperative PaO2/FiO2 (229.7 ±â€…91.4 vs 299.7 ±â€…101.2mmHg, P < .001) was significantly lower than those in the non-hypoxemia group. In the hypoxemia group, PaO2/FiO2 before extubating was significantly higher than that after operation, and the difference was significant. Logistic regression analysis showed that overweight (odds ratio [OR]: 1.113, P = .030), CPB time (OR: 1.009, P = .043) and preoperative PaO2/FiO2 (OR: 0.994, P = .001) were independent risk factors for postoperative hypoxemia. Further follow-up results showed no significant difference in long-term mortality between the 2 groups. Logistic regression analysis revealed that PaO2/FiO2 before extubating (OR: 0.985, P < .001), paraplegia (OR: 10.994, P = .019), acute renal failure (OR: 12.590, P < .001), re-operation (OR: 4.721, P = .014) and re-admission to intensive care unit (OR: 13.727, P = .001) were independent risk factors for long-term mortality. Our results showed that overweight and prolonged CPB time were risk factors for postoperative hypoxemia in ATAAD patients. While PaO2/FiO2 before extubating were independent risk factors for long-term mortality, indicating that active correction of hypoxemia and maintain a higher PaO2/FiO2 before extubating may help to improve the prognosis of the ATAAD patients.

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis.

BACKGROUND: Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis. However, few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis. Moreover, no consensus on goal enteral caloric intake has been reached in sepsis. AIM: To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis. METHODS: Patients were randomly assigned to receive 30% (defined as group A), 60% (group B), or 100% (group C) of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial. The acute gastrointestinal injury (AGI) grades, incidence of feeding intolerance (FI), daily caloric intake, nutritional and inflammatory markers, and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding. The clinical severity and outcome variables were also recorded. RESULTS: A total of 54 septic patients were enrolled. The days to goal calorie of group C (2.55 ± 0.82) were significantly longer than those of group A (3.50 ± 1.51; P = 0.046) or B (4.85 ± 1.68; P < 0.001). The FI incidence of group C (16.5%) was higher than that of group A (5.0%) or B (8.7%) (P = 0.009). No difference in the incidence of FI symptoms was found between groups A and B. The serum levels of barrier function biomarkers of group B were significantly lower than those of group A (P < 0.05) on the 7th day of feeding. The prealbumin and IL-6 levels of group A were lower than those of group B (P < 0.05) on the 7th day of feeding. No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups. CONCLUSION: Early moderate enteral underfeeding (60% of goal requirements) could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis. However, further large-scale prospective clinical trials and animal studies are required to test our findings. Moreover, the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.

Interleukin-9 promotes intestinal barrier injury of sepsis: a translational research.

BACKGROUND: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Intestinal mucosal barrier injury is one of the important manifestations of sepsis. Interleukin-9 (IL-9) and IL-9-producing CD4(+) T cells were emerging pro-inflammatory mediators with development of intestinal injury. However, it is unclear whether IL-9 is related to the intestinal barrier injury of sepsis. METHODS: To investigate the roles of IL-9-producing CD4(+) T cells and IL-9 in the process of barrier injury in sepsis, serum IL-9-producing CD4(+) T cell percentages, IL-9, and D-lactate levels were measured in septic patients and controls. The markers of barrier function in serum and intestinal tissue were also collected in septic rats. Moreover, the barrier injury degree and survival rate of septic rats were also investigated after increasing or interfering with IL-9 expression. RESULTS: The serum IL-9-producing CD4(+) T cell percentages, IL-9, and D-lactate levels were significantly higher in septic patients or rats than those in controls. IL-9-producing CD4(+) T cells and IL-9 levels were positively correlated with D-lactate levels and had a high predictive value of 28-day mortality in septic patients. The non-survivors had significantly higher serum T cell percentages, IL-9, and D-lactate levels compared with survivors. In septic rats, IL-9 increased the expression levels of D-lactate, whereas that decreased the expression levels of zonula occludens 1. Moreover, the barrier injury was aggravated or alleviated by increasing or interfering with IL-9 expression, respectively. Survival rate analysis also showed that IL-9 decreased the 14-day survival rate of septic rats. CONCLUSION: IL-9 is closely related to intestinal mucosal barrier injury and mortality in sepsis. IL-9 blockade has the potential to improve the barrier injury in sepsis. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (ID: NCT03791866, Date: December 2018).

[Surgical treatment of post-infarction left ventricular aneurysm: clinical analysis].

OBJECTIVE: To explore the clinical experiences, efficacies and postoperative left ventricular remodeling changes of surgical ventricular reconstruction in the treatment of post-infarction left ventricular aneurysm. METHODS: The investigators reviewed retrospectively the clinical data, operative approaches and follow-up outcomes of consecutive 194 patients with post-infarction left ventricular aneurysm, who underwent surgical ventricular reconstruction between January 1997 and December 2009. There were 54 cases in the linear group and 137 cases in the endoventricular patch plasty group. The changes of ventricular remodeling were measured by peri-operative and follow-up echocardiography. RESULTS: All patients underwent surgery with a mean cardiopulmonary bypass duration of (103 ± 35) min and aortic cross clamp duration of (62 ± 26) min. There were 8 per-operative deaths with a mortality rate of 2.2%. Angina pectoris of other cases disappeared and heart function greatly improved. After operation, the ventricular remodeling results showed that in the linear group, there was not significant difference in the changes of ventricular remodeling of post-op 2 weeks, 6 months, 1 year and 5 years versus pre-operation. However, in the endoventricular patch group, the changes of ventricular remodeling of post-op 2 weeks and follow-up 6 months versus pre-operation were significantly reduced (P < 0.05). End-systolic volume (LVESV) reduced from (129 ± 27) ml to (65 ± 8) ml and end-systolic volume index (LVESVI) decreased from (104 ± 14) ml/m(2) to (44 ± 6) ml/m(2) and the subgroup of LVEF < 35% was the most significant in the changes of LVESV and LVESVI. But LVEF improved significantly at post-operation and follow-up (from preoperation 42% ± 11% to 52% ± 7% during follow-up). CONCLUSIONS: For patients with infarction left ventricular aneurysm, left ventricular reconstruction is quite effective. The choice of operative approaches is determined by the size and range of ventricular aneurysm. Both string suture and endoventricular patch plasty technique can yield similarly satisfactory surgical outcomes. After operation, ventricular volume significantly decreases and cardiac function greatly improves.

Heparin-binding protein as a biomarker of gastrointestinal dysfunction in critically ill patients: a retrospective cross-sectional study in China.

OBJECTIVE: To investigate the association of plasma heparin-binding protein (HBP) with the development of acute gastrointestinal injury (AGI) in critically ill patients. DESIGN: Clinical retrospective cross-sectional study. SETTING: A general teaching hospital in China. PARTICIPANTS: Adult patients (age ≥18 years) admitted to our department with an intensive care unit (ICU) stay ≥5 days. MAIN OUTCOME MEASURES: HBP levels were recorded twice or more within 5 days after admission. The initial AGI grades and the worst AGI grades within 5 days after admission, the number of patients receiving total enteral nutrition (TEN) and the number of patients with feeding intolerance (FI) and with sepsis were also recorded, along with some clinical severity and outcome variables. RESULTS: From June 2018 to May 2019, 221 patients were enrolled in this study. We divided patients into four groups based on the HBP values: HBP ≤20 ng/mL, 20100 ng/mL. Significant differences were found in the ratios of AGI deterioration and TEN and the incidence rates of FI and sepsis among the four groups. Differences were also found among the groups regarding the worst AGI grades. The area under receiver operating characteristic curves for AGI deterioration, severe AGI (grades II or above), TEN and FI were 0.738 (p=0.001), 0.774 (p<0.001), 0.810 (p<0.001) and 0.729 (p=0.001), respectively. The optimal HBP cut-off values for AGI deterioration and severe AGI were 53.27 ng/mL and 41.26 ng/mL, respectively. However, no differences in ICU duration or 28-day mortality were found. CONCLUSIONS: HBP levels were associated with gastrointestinal dysfunction in critically ill patients. Increased HBP was positively correlated with sepsis but it was not correlated with 28-day mortality.

Effects of early enteral nutrition on Th17/Treg cells and IL-23/IL-17 in septic patients.

BACKGROUND: The imbalance of Th17/Treg cells and the IL-23/IL-17 axis have been confirmed to be associated with sepsis and various inflammatory diseases. Early enteral nutrition (EEN) can modulate the inflammatory response, improve immune dysfunction, and prevent enterogenic infection in critically ill patients; however, the precise mechanisms remain unclear. Considering the important roles of Th17 and Treg lymphocytes in the development of inflammatory and infectious diseases, we hypothesized that EEN could improve the immune dysfunction in sepsis by maintaining a balanced Th17/Treg cell ratio and by regulating the IL-23/IL-17 axis. AIM: To investigate the effects of EEN on the Th17/Treg cell ratios and the IL-23/IL-17 axis in septic patients. METHODS: In this prospective clinical trial, patients were randomly divided into an EEN or delayed enteral nutrition (DEN) group. Enteral feeding was started within 48 h in the EEN group, whereas enteral feeding was started on the 4th day in the DEN group. The Th17 and Treg cell percentages and the interleukin levels were tested on days 1, 3, and 7 after admission. The clinical severity and outcome variables were also recorded. RESULTS: Fifty-three patients were enrolled in this trial from October 2017 to June 2018. The Th17 cell percentages, Th17/Treg cell ratios, IL-17, IL-23, and IL-6 levels of the EEN group were lower than those of the DEN group on the 7th day after admission (P < 0.05). The duration of mechanical ventilation and of the intensive care unit stay of the EEN group were shorter than those of the DEN group (P < 0.05). However, no difference in the 28-d mortality was found between the two groups (P = 0.728). CONCLUSION: EEN could regulate the imbalance of Th17/Treg cell ratios and suppress the IL-23/IL-17 axis during sepsis. Moreover, EEN could reduce the clinical severity of sepsis but did not reduce the 28-d mortality of septic patients.

[Association between urinary neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery].

OBJECTIVE: To test the hypothesis that Neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker for acute kidney injury (AKI) in patients after cardiac surgery. METHODS: 33 cases undergoing cardiac surgery were divided into AKI group and Non-AKI group according to the AKI criteria. The concentration of urine NGAL at different time points were measured. RESULTS: (1) Nine of 33 cases (27%) developed postoperative AKI, but diagnosis with serum creatinine was only 12-48 hours after cardiac surgery. (2)Urinary concentrations of NGAL at 2 h after cardiac surgery in patients who did not developed AKI were significantly higher compared with those of preoperative (P < 0.001). Urinary concentrations of NGAL at 2 h and 4 h after cardiac surgery in patients who developed AKI were significantly higher compared with those of preoperative (P < 0.001). (3) The mean urinary NGAL concentrations in patients who developed AKI were significantly higher after surgery compared with patients who did not develop AKI (P < 0.01). (4) Urinary concentrations of NGAL/Ucr at 2 h and 4 h after cardiac surgery in patients who did not developed AKI were significantly higher compared with those of preoperative (P < 0.05). Urinary concentrations of NGAL/Ucr at 2 h and 4 h after cardiac surgery in patients who developed AKI were significantly higher compared with those of preoperative (P < 0.01). (The mean urinary concentrations of NGAL/Ucr in patients who developed AKI were significantly higher after surgery compared with patients who did not develop AKI (P < 0.01). (6) For concentrations in urine of NGAL at 2 h after surgery, sensitivity was 0.7125, and specificity was 0.7307 for a cutoff value of 250 microg/L. For concentrations in urine of NGAL/Ucr at 2 h after surgery, sensitivity was 0.8127, and specificity was 0.7839 for a cutoff value of 250 microg/mmol. (7) Urinary concentrations of NGAL at 2 h after cardiac surgery was significantly associated with serum creatinine 12 h postoperative (R = 0.638, P < 0.05). CONCLUSIONS: The incidence of AKI in patients after cardiac surgery is high, which accounted for 27%. The amount of NGAL and NGAL/Ucr in urine at 2 h after cardiac surgery were the powerful independent predictor of acute renal injury and urine concentrations of NGAL/Ucr is more sensitive.

Effects of early enteral nutrition on T helper lymphocytes of surgical septic patients: A retrospective observational study.

The aim of this study was to investigate the effects of early enteral nutrition (EEN) on T helper lymphocytes and the subpopulations ratios of surgical septic patients.We performed a retrospective study including 107 eligible patients from February 2014 to December 2015. Patients were divided into EEN, delayed enteral nutrition (DEN), or total parenteral nutrition (TPN) group according to the duration before enteral feeding. Th1, Th2, Th17, and Treg lymphocyte percentages were collected on days 3, 7, and 14 after admission. The disease severity and clinical outcome variables were also recorded.The Th1, Th17 percentages, and Th1/Th2, Th17/Treg ratios of EEN group were significantly lower than those of DEN or TPN group on the 14th day after admission (P < .05). Compared with TPN, DEN might have a tendency to decrease the Th1 and Th17 percentages. EEN could improve the disease severity and clinical outcomes of septic patients, however, no difference on 28-day mortality was found between EEN and DEN group.EEN could improve the dysregulation of Th1/Th2 and Th17/Treg ratios during early stage of sepsis. Compared with DEN, EEN could improve the disease severity and clinical outcomes, but not decrease the 28-day mortality of surgical septic patients.

Risk factors and prognosis of hypoalbuminemia in surgical septic patients.

The aim of this study was to investigate the risk factors of hypoalbuminemia and effects of different albumin levels on the prognosis of surgical septic patients. We preformed a retrospective clinical study including 135 adult patients from September 2011 to June 2014. The albumin levels and severity markers were recorded during the first 48 h after enrollment, and logistic regression analyses were used to determine the risk factors. The outcomes of patients with different albumin levels were also compared. The acute physiology and chronic health evaluation II (APACHE II) score (OR 1.786, 95% CI [1.379-2.314], P < 0.001), C-reactive protein (CRP) (OR 1.016, 95% CI [1.005-1.027], P = 0.005), and blood lactate (OR 1.764, 95% CI [1.141-2.726], P = 0.011) were established as the independent risk factors of hypoalbuminemia in patients with surgical sepsis. The severity markers and outcomes of patients with albumin levels ≤20 g/L were significantly worse than that of 21-25 g/L and ≥26 g/L, whereas the latter two groups had similar prognosis. Every 1 g/L decrease of albumin level below the optimal cut-off (23 g/L) was associated with a 19.4% increase in hospital mortality and a 28.7% increase in the incidence of multiple organ dysfunction syndrome. In conclusion, APACHE II score (≥14.5), CRP (≥34.25 mg/L), and blood lactate (≥.35 mmol/L) were established as the independent risk factors of hypoalbuminemia in the early stage of surgical sepsis. Patients with baseline albumin level ≤20 g/L had worse prognosis than that of albumin level ≥21 g/L. Albumin levels were negatively correlated the prognosis of surgical sepsis when below about 23 g/L.

Comparative study of on-pump and off-pump coronary bypass surgery in patients with triple-vessel coronary artery disease.

BACKGROUND: Studies on selected patients undergoing off-pump versus on-pump coronary artery bypass surgery have produced inconsistent results, especially in patients with multiple coronary artery disease. This study compared the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease. METHODS: A total of 300 consecutive isolated, multiple coronary artery bypass grafting (CABG) patients were assigned to the off-pump coronary artery bypass (OPCAB, n = 150) or CABG with cardiopulmonary bypass (CCABG, n = 150) groups. There were no significant differences regarding degree of angina, history of myocardial infarction or diabetes, and presence of left main coronary artery disease between the two groups. Ejection fraction in the OPCAB group before surgery was lower than in the CCABG group (P < 0.01). In addition, more patients had a history of stroke and abnormal renal function preoperatively in the OPCAB group (P < 0.01). In OPCAB patients, single deep pericardial stay suture with a sling snared down was used to expose the target vessels, along with a stabilizer and a coronary shunt. A Medi-Stim Butterfly Flowmeter was used to measure blood flow through grafts in both groups. RESULTS: No OPCAB patient was converted to the CCABG group. The average numbers of distal anastomoses and the indexes of completeness of revascularization (ICR) were similar in both groups. Postoperative respiratory support time and the volumes of chest tube drainage and of blood transfusions were less in the OPCAB group than in the CCABG group (both P < 0.01). The postoperative incidences of pulmonary dysfunction and renal insufficiency were lower in the OPCAB group than in the CCABG group (both P < 0.05). There were no significant differences between the two groups in mortality and other causes of morbidity (perioperative myocardial infarction, stroke, atrial fibrillation). CONCLUSIONS: OPCAB can be applied to patients with triple-vessel coronary artery disease and can achieve similar completeness of revascularization and similar early surgical results, with shorter respiratory support, reduced transfusion requirement, and fewer cases of pulmonary dysfunction and abnormal renal function.

Effects of early enteral nutrition on immune function of severe acute pancreatitis patients.

AIM: To investigate the effects of early enteral nutrition (EEN) on the immune function and clinical outcome of patients with severe acute pancreatitis (SAP). METHODS: Patients were randomly allocated to receive EEN or delayed enteral nutrition (DEN). Enteral nutrition was started within 48 h after admission in EEN group, whereas from the 8(th) day in DEN group. All the immunologic parameters and C-reactive protein (CRP) levels were collected on days 1, 3, 7 and 14 after admission. The clinical outcome variables were also recorded. RESULTS: Sixty SAP patients were enrolled to this study. The CD4+ T-lymphocyte percentage, CD4+/CD8+ ratio, and the CRP levels in EEN group became significantly lower than in DEN group from the 7(th) day after admission. In contrast, the immunoglobulin G (IgG) levels and human leukocyte antigen-DR expression in EEN group became significantly higher than in DEN group from the 7(th) day after admission. No difference of CD8+ T-lymphocyte percentage, IgM and IgA levels was found between the two groups. The incidences of multiple organ dysfunction syndrome, systemic inflammatory response syndrome, and pancreatic infection as well as the duration of intensive care unit stay were significantly lower in EEN group than in DEN group. However, there was no difference of hospital mortality between the two groups. CONCLUSION: EEN moderates the excessive immune response during the early stage of SAP without leading to subsequent immunosuppression. EEN can improve the clinical outcome, but not decrease the hospital mortality of SAP patients.