Predictors of enteral nutrition intolerance in severe acute pancreatitis: a meta-analysis

Enteral nutrition is a key part of the management of severe acute pancreatitis (SAP) but often is associated with enteral nutrition intolerance (ENI), thereby affecting patient outcomes. This meta-analysis evaluates the incidence and predictive factors of ENI in SAP patients. A comprehensive literature search across multiple databases. Data extraction focused on ENI incidence and associated factors: patients’ age, APACHE II score, albumin (ALB), serum intra-abdominal pressure (IAP), central venous pressure (CVP), soluble dietary fiber (SDF), and prolonged fasting > 72 h. Heterogeneity was assessed using the I² statistic, and pooled estimates were calculated via random- or fixed-effects models. Sensitivity analysis and publication bias evaluation were performed. A total of 26 observational studies involving 3,284 SAP patients were included. Among 2,076 SAP patients, the pooled incidence of ENI was 36%. Older age (> 60/65 years) was positively associated with ENI risk. Higher APACHE II score correlated with increased ENI risk. Elevated IAP significantly predicted ENI. Prolonged fasting time (> 72 h) increased ENI likelihood and high CVP levels also associated with the increased risk of ENI. Usage of SDF presents protect effect on ENI. Sensitivity analysis revealed the reliable of the results in each predictive factor. No publication bias was found across the included studies. The meta-analysis demonstrated that ENI affects over one-third of SAP patients, with older age, high APACHE II score, IAP, CVP, low ALB and prolonged fasting (> 72 h) and usage of SDF identified as key predictors.