Pancreatic enzyme replacement therapy can improve infection level nutrition condition and prognosis of patients with sepsis

Li  Zhao; Sheng Wang

doi:10.29219/fnr.v69.12746

Li Zhao Department of Critical Care Medicine, Taikang Tongji (Wuhan) Hospital, Wuhan, 430050, Hubei Province, P.R. China
Sheng Wang Department of Critical Care Medicine, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, 200072, P.R. China

DOI: https://doi.org/10.29219/fnr.v69.12746

Keywords: exocrine pancreatic, insufficiency, pancreatic enzyme replacement therapy, sepsis

Abstract

Objective: This study aimed to investigate the effects of pancreatic enzyme replacement therapy (PERT) on infection level, nutrition condition and prognosis of patients with sepsis.

Method: According to the fecal elastase-1 (FE1) level, 68 sepsis patients who were diagnosed with pancreatic exocrine insufficiency (PEI) from 2014.11 to 2015. 12 in our hospital were randomly divided into two groups: regular nutritional support (RNS) group or PERT group. A total of 15 patients were dropout for various reasons.

Finally, 25 patients were enrolled in PERT group and 28 in RNS group. APACHEII score, SOFA score, inflammatory biomarkers including C-reaction protein (CRP), white blood cell (WBC), procalcitonin (PCT), nutrition markers including prealbumin (PA), transferrin (TFN), retinol binding protein (RBP), creatinine/height index (CHI) were recorded at the day 1 (D1), day7 (D7) and day14 (D14) since they were admitted in ICU. These data were compared between and within the two groups chronologically. Also, the duration of vasoactive drug using (DVAD), mechanical ventilation (DMV), length of stay in ICU (LOS) and survival rate within 14 days were compared between the two groups.

Results: There were no differences in general information (Age and gender) between PERT and RNS groups. Compared with the RNS group, CRP, WBC and PCT declined significantly at D14 in the PERT group. Especially, CRP declined significantly over time in both groups. In addition, compared with the RNS group, in the PERT group at D14, nutrition markers, including PA, TFN, RBP and CHI increased significantly, APACHEII score and SOFA score decreased significantly. And DVAD, DMV and LOS were significantly shortened in PERT group, but the survival rate within 14 days was not significantly changed.

Conclusion: The PERT can improve infection level, nutrition condition and prognosis of patients with sepsis. And the underlying mechanism may be related to improve pancreatic exocrine insufficiency of these patients.

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