Risk factors for enteral nutrition intolerance and its impact on prognosis in patients with severe acute pancreatitis

BACKGROUND Severe acute pancreatitis (SAP) affects 10%-20% of acute pancreatitis patients, with mortality rates of up to 30%, requiring early enteral nutrition (EN) within 24-48 hours per the European Society for Clinical Nutrition and Metabolism guidelines. However, intolerance to EN occurs in 25%-40% of SAP patients due to gastrointestinal dysfunction, leading to prolonged intensive care unit stays, increased infections, and compromised survival outcomes. AIM To investigate the risk factors for EN intolerance in patients with SAP and its impact on prognosis, providing evidence for clinical nutrition therapy strategies. METHODS A retrospective cohort study design was adopted, and the clinical data of 195 SAP patients of our hospital were collected from January 2019 to June 2025. Patients were divided into an intolerance group (76 patients) and a tolerance group (119 patients) according to their EN intolerance status. Multivariate logistic regression analysis was used to identify independent risk factors for EN intolerance, and a Cox proportional hazards regression model was used to analyze independent factors affecting 28-day mortality. RESULTS The incidence of EN intolerance in SAP patients was 39.0%. Multivariate logistic regression analysis revealed that the Acute Physiology and Chronic Health Evaluation II score [odds ratio (OR) = 1.124, 95% confidence interval (CI): 1.042-1.213, P = 0.002], serum albumin level (OR = 0.879, 95%CI: 0.801-0.965, P = 0.006), and intra-abdominal pressure (OR = 1.152, 95%CI: 1.063-1.248, P = 0.001) were independent risk factors for EN intolerance. The 28-day mortality rate in the intolerance group was significantly greater than that in the tolerance group (25.0% vs 12.6%, P = 0.025). Cox regression analysis revealed that EN intolerance (hazard ratio = 2.164, 95%CI: 1.127-4.156, P = 0.020) was an independent risk factor for 28-day mortality CONCLUSION The incidence of EN intolerance in SAP patients is high, with the Acute Physiology and Chronic Health Evaluation II score, serum albumin level, and intra-abdominal pressure being independent risk factors. EN intolerance significantly increases the risk of mortality in patients and is an independent risk factor affecting prognosis. Early identification of high-risk factors and the development of individualized nutrition therapy strategies are crucial for improving patient outcomes.