RESUMEN
Nutrition support is a key method to treat acute pancreatitis (AP). Enteral nutrition (EN) has a role in treating AP, but the time point for EN initiation remains unclear. The present systematic review and meta-analysis aimed to assess the efficacy of early EN (EEN) and delayed EN (DEN) based on different time points (24, 48 and 72 h). The relevant databases including Pubmed, Web of Science, Embase and Cochrane library were searched until Dec 1, 2022. Studies comparing EEN and DEN in AP were included. The relative risk (RR) was used for comparing categorical variables, while standard mean difference (SMD) was used for continuous variables, both reported with 95% CI. A total of 17 studies with 1,637 patients with AP was included in the present systematic review and meta-analysis. The patients in the DEN group showed a significantly higher risk of mortality compared with the EEN group (RR=1.95; 95% CI, 1.21-3.14; P=0.006). In subgroup analysis, when using 48 h as the cut-off time to distinguish EEN and DEN, the risk of mortality was 3.89-fold higher in the DEN group compared with that in the EN group (95% CI, 1.25-12.17; P=0.019). DEN also increased the occurrence of sepsis in patients with AP (RR=2.82; 95% CI, 1.10-7.18; P=0.03) and duration of hospital stay (P<0.001). The present systematic review and meta-analysis suggested that EEN decreased associated complications, length of hospitalization and mortality in patients with AP and therefore provided a safe approach to improve recovery but there is still controversy around the time point for EEN.
RESUMEN
Objective: This meta-analysis aimed to determine the prognostic performance of quick sequential organ failure assessment (qSOFA) score in comparison to systemic inflammatory response syndrome (SIRS) in predicting in-hospital mortality in the emergency department (ED) patients. Methods: Eligible studies comparing the performance of qSOFA and SIRS in predicting in-hospital death of ED patients were identified from searching PubMed, Embase, and Cochrane. Raw data were collected, and the pooled sensitivity and specificity were calculated for qSOFA and SIRS. The summary receiver operating curve was also plotted to calculate the area under the curve. Results: A total of 16 prospective studies with 35,756 patients and 2,285 deaths were included. The pooled sensitivity was 0.43 (95% CI: 0.32-0.54) and 0.8 (95% CI: 0.73-0.86) for qSOFA and SIRS, respectively. The pooled specificity was 0.89 (95% CI: 0.84-0.93) and 0.39 (95% CI: 0.3-0.5) for qSOFA and SIRS, respectively. The area under the summary receiver operating curve was 0.76 (95% CI: 0.72-0.8) and 0.67 (95% CI: 0.62-0.72) for qSOFA and SIRS, respectively. A significant heterogeneity was observed for both qSOFA and SIRS studies. Conclusion: The present meta-analysis suggested that qSOFA had a higher specificity but a lower sensitivity as compared with SIRS in predicting in-hospital mortality in the ED patients. qSOFA appeared to be a more concise and simple way to recognize patients at high risk for death. However, the use of SIRS in the ED cannot be completely replaced since the sensitivity of qSOFA was relatively lower.