{"paper_id":"3df1eaa8-35b9-4af1-9f2f-21f4d4d4eb3f","body_text":"Relationship Between Early Enteral Nutrition and BISAP Score with Duration of Hospitalization in Patients with Acute Edematous Pancreatitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship Between Early Enteral Nutrition and BISAP Score with Duration of Hospitalization in Patients with Acute Edematous Pancreatitis Murat AY, Osman Saglam, Alper Sari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6879794/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: The main objective of our study was to examine and demonstrate the contribution of early enteral nutrition support to the disease prognosis and duration of hospitalization, in appropriate cases diagnoes with well-defined acute pancreatitis. Materials and Methods: This cross-sectional study included 84 patients admitted to the Internal Medicine clinic with a diagnosis of acute edematous pancreatitis. In order to reveal the statistical relationship of early enteral nutrition support on hospitalization and mortality during the treatment process, patients who received the same infusion protocol and the same intravenous fluid were included in the study. The number of hours after the patients were started on enteral nutrition support was determined. Results: The effect of BISAP score on the initiation of enteral nutrition was evaluated by Binary Logistic Regression analysis. A BISAP score of 3 and above significantly (OR=29.167; CI: 4.634-183.576) increased the duration of enteral nutrition initiation longer than 72 hours. Discussion : There are no studies on the relationship between early enteral nutrition and BISAP score and duration of hospitalization. Since the BISAP score is calculated according to the clinical evaluation in the first 24 hours and its statistical relationship with mortality has been demonstrated in the literature, we thought to reveal the relationship between early enteral nutrition support and hospitalization duration in the evaluation of the course, severity and prognosis of acute pancreatitis. Conclusions: We think that early enteral nutrition ≤72 hours in patients with acute pancreatitis will provide a significant reduction in hospitalization time and complications. acute pancreatitis early enteral feeding BISAP score hospitalization Main Points Early initiation of enteral nutrition in patients diagnosed with acute pancreatitis is associated with a reduction in hospitalization duration. Early initiation of enteral nutrition in patients diagnosed with acute pancreatitis is associated with a reduction in disease complications. A BISAP score >3 in patients diagnosed with acute pancreatitis has been found to be associated with failure to provide early enteral nutrition. Introduction Acute pancreatitis is the most commDYon gastroenterologic disease requiring hospitalization. Most patients present with mild acute pancreatitis that is self-limiting and usually resolves within 1 week. Approximately 20% of patients develop moderate to severe acute pancreatitis with pancreatic or peripancreatic tissue necrosis or organ failure or a combination of both clinical pictures and this picture has a mortality rate of 20–40% ( 1 , 2 ). The most common presentation of acute pancreatitis is severe upper abdominal pain, and two of the following three criteria must be present for diagnosis: 1.) upper abdominal pain, 2.) serum amylase or lipase (or both) at least three times the upper normal limit, 3.) findings consistent with acute pancreatitis on contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), or abdominal ultrasound ( 3 ). Usually necrotizing pancreatitis is detected by imaging 72–96 hours after the findings ( 3 ). According to current guidelines, etiological evaluation should be performed at an early stage ( 3 ). In terms of etiology, gallstones (40–70%) and alcohol consumption (25–35%) are among the most common causes of acute pancreatitis ( 4 ). Less common causes include medications, endoscopic retrograde cholangiopancreatography (ERCP), hypercalcemia, hypertriglyceridemia, infections, genetic factors, autoimmune diseases, surgery, and trauma, particularly trauma that damages the pancreatic duct ( 5 ). In hypertriglyceridemia, especially triglyceride levels > 1000 mg/dL trigger acute pancreatitis attacks, but it has been shown that lower triglyceride levels can also trigger attacks ( 6 ). Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ), Ranson score and Acute Pancreatitis Bedside Severity Index (BISAP) score; biochemistry tests such as C-reactive protein (CRP) and blood urea nitrogen (BUN) are used in routine practice to determine the severity of acute pancreatitis ( 7 ). In line with current recommendations, systemic inflammatory response syndrome (SIRS) or end-organ damage should be assessed for at least 48 hours from the time of presentation in order to predict the course of the disease ( 8 ). The severity classification of acute pancreatitis is defined as mild, moderate, or severe according to the revised Atlanta classification ( 9 ). When evaluated using the revised Atlanta classification criteria, the severity of acute pancreatitis is categorized into three groups based on the presence of organ dysfunction and local (pancreatic or peripancreatic fluid accumulation or portal vein thrombosis) or systemic complications (exacerbation of comorbidities). When there are no local or systemic complications or organ failure, acute pancreatitis is classified as “mild” ( 9 ). Conservative treatment is usually sufficient in cases of mild acute pancreatitis. The absence of local or systemic complications and permanent organ failure in acute pancreatitis is categorized as “moderate” ( 9 ). The development of permanent single or multiple organ failure in the clinical presentation of acute pancreatitis is classified as “severe” and is associated with a mortality rate of 20–40% ( 1 ). In interstitial edema of the pancreas, homogeneous fluid-containing accumulations that develop during the first 4 weeks of the disease are referred to as acute pancreatic or peripancreatic fluid accumulations. These accumulations typically regress without requiring intervention. If these accumulations persist for more than 4 weeks from the onset of the disease, pancreatic pseudocysts may develop. In necrotizing pancreatitis, accumulations that form within the first 4 weeks of the disease onset are referred to as “acute necrotic accumulations.” Acute necrotic collections are usually called \"walled-off\" necrosis when they mature and encapsulate after the first 4 weeks ( 9 ). The cornerstones of acute pancreatitis treatment are fluid resuscitation, pain palliation and nutrition. In acute pancreatitis, hypovolemia and end-organ failure may occur with fluid extravasation into the third space accompanied by a systemic immune response. Therefore, appropriate and adequate fluid resuscitation maintains intravascular volume and increases microperfusion and organ perfusion. Favorable effects of optimal fluid resuscitation on clinical outcomes have been demonstrated in the early clinical course of the disease ( 10 ). Although there are various publications in the literature regarding optimal fluid resuscitation, current guidelines recommend a heart rate < 120/min, mean arterial pressure (MAP): 65–85 mm Hg and urine output > 0.5-1.0 mL/kg/hour ( 3 ). However, multicenter randomized multicenter study by Enrique de-Madaria et al. comparing aggressive (20 mL/kg loading followed by 3 mL/kg maintenance) and moderate (10 mL/kg loading followed by 1.5 mL/kg maintenance) fluid resuscitation with Ringer's lactate solution in patients with acute pancreatitis concluded that early aggressive fluid resuscitation was associated with fluid overload without clinical improvement ( 11 ). Fluid resuscitation with Ringer's lactate solution was associated with less SIRS development and lower CRP levels compared to fluid resuscitation with normal saline ( 12 ). Nutritional support is a cornerstone of treatment in pancreatitis. Optimal nutritional support maintains intestinal barrier function, prevents bacterial translocation and reduces SIRS ( 13 ). Parenteral nutrition is not recommended over enteral nutrition due to increased risk of complications, atrophy of the intestinal mucosa, increased permeability of the intestinal mucosal barrier and mortality ( 14 ). Although the role of activation of inflammatory and proteolytic cascades as the underlying mechanism in acute pancreatitis is known, there are studies suggesting that cell signaling is triggered by bacterial infections. As a result of bacterial translocation, macrophages, circulating neutrophils and granulocytes are stimulated and pro-inflammatory cytokines are released. As a result of this imbalance in the inflammatory response, SIRS, infectious pancreatic necrosis and multiple organ failure may develop ( 15 ). According to meta-analyses by Marik and Zaloga and McClave et al., early enteral nutrition has been shown to be associated with a reduction in hospitalization and infection-related complications ( 16 , 17 ). If bacterial translocation can be prevented by maintaining the intestinal barrier with enteral nutrition, early initiation of enteral nutrition is recommended. In summary, early initiation of enteral nutrition in the clinical course of acute pancreatitis has been associated with a reduction in the length of hospitalization ( 18 ). Although there are many publications on acute pancreatitis in the literature, the majority of these are on fluid management, pain palliation and pancreatitis complications. There are only a limited number of studies in the literature that associate early enteral nutrition in acute pancreatitis with the course of pancreatitis and hospitalization. In particular, there are no studies in the literature on the BISAP score, one of the currently frequently used acute pancreatitis severity scoring indices, and its relationship with the duration of hospitalization and transition to early enteral nutrition. The primary objective of our study was to investigate and demonstrate the contribution of early enteral nutritional support to disease prognosis and length of hospital stay in appropriate cases with a well-defined diagnosis of acute pancreatitis. Materials and Methods Our study was conducted cross-sectionally and consists of data from 83 patients diagnosed with acute edematous pancreatitis and followed up at the Internal Medicine Clinic between 01.07.2022-01.07.2024. Study Design The patient group included in our study is given below Patients between 18–92 years of age who were interned to the Internal Medicine Clinic with a diagnosis of acute edematous pancreatitis, Patients with no cause of internation other than acute edematous pancreatitis, Patients who do not require any treatment other than treatment of acute edematous pancreatitis, Patients on the same intravenous fluid protocol, Patients who are cooperative, have no mental or psychiatric defect and no diagnosis of psychiatric illness, Patients without illicit drug use, Patients with enteral nutrition adherence, Patients who did not require intensive care at any time during the internation process and who were followed up only by the ward team in the Internal Medicine clinic, where treatments prepared according to the protocol in accordance with the algorithm were applied. The patient group not included in our study is given below: Patients under 18 years of age and patients over 92 years of age, Patients with active infection requiring prolonged hospitalization for other etiologies, Patients who cannot tolerate active enteral nutrition, Patients with necrotizing and severe pancreatitis, Patients with biliary acute pancreatitis, Patients with cognitive dysfunction, Patients with a history of non-pancreatitis internation indication, Patients with autoimmune and chronic pancreatitis, Patients with pancreatic malignancy, Patients with cholangitis and cholecystitis, Patients on parenteral nutrition, Patients with acute renal failure diagnoses at and before internationalization, Patients diagnosed with chronic renal failure, Patients receiving medical treatment causing hyperuricemia, Patients whose acute respiratory distress syndrome (ARDS) clinic developed at the time of diagnosis or during ward follow-up, Patients with active lung infection, Patients on antibiotherapy. Patients with imaging findings suggestive of acute edematous pancreatitis were included in the study. According to the American Gastroenterological Association (AGA) and the revised Atlanta classification (2012) ( 19 ); the diagnosis of acute pancreatitis is based on abdominal pain consistent with acute pancreatitis, at least a threefold increase in serum lipase or amylase, and radiological findings suggestive of acute pancreatitis on ultrasound, magnetic resonance imaging, or computed tomography. Patients with acute edematous pancreatitis who developed necrotizing and severe pancreatitis at diagnosis or follow-up were excluded from the study. Of the 84 patients included in the study, age, internation and externation dates were first determined. The vital follow-up forms of the patients were analyzed after internation. In the follow-up of all patients, Ringer's lactate fluid resuscitation protocol was applied in 5 ml/kg loading and then 1.5 ml/kg maintenance protocol. Afterwards, the comorbidities of the patients were evaluated for hypertriglyceridemia, which is the most common etiology of acute pancreatitis, and alcohol consumption. Biliary pancreatitis cases were excluded because they could not be objectively evaluated due to late transition to enteral nutrition. In order to reveal the statistical relationship of early enteral nutrition support on hospitalization and mortality during the treatment process, patients who received the same infusion protocol and the same intravenous fluid were included in the study. It was determined how many hours after the patients were started on enteral nutrition support. The parameters used in the evaluation of BISAP score ( 20 ) are given below: Blood urea nitrogen (BUN) > 25 mg/dL Signs of impaired mental function ≥ 2 Systemic inflammatory response syndrome (SIRS) * findings Age > 60 Presence of pleural effusion *: The presence of SIRS signs requires the presence of two of the following findings: body temperature (< 36° or > 38°), heart rate > 90/min, respiratory rate > 20/min or PaCO 2 < 32 mm Hg, leukocyte count > 12,000 or < 4,000/mm 3 . A BISAP score of < 2 has been associated with 0-0.5% mortality and ≥ 3 with 5–20% mortality ( 20 ). Statistical Analysis Descriptive statistics (arithmetic mean, median, standard deviation, percentage, etc.) were evaluated using IBM SPSS 25v package program. Compliance with normal distribution was checked by Shapiro Wilk test. Chi-Square test was used for intergroup differences of qualitative variables. Mann Whitney U test was used for intergroup differences of quantitative variables that were not normally distributed. The effect of BISAP score on transition to early enteral nutrition regimen was evaluated by Binary Logistic Regression Analysis. P < 0.05 was used for statistical significance. Ethics Committee : The study was approved by Afyonkarahisar Health Sciences University Clinical Research Ethics Committee decisions on 02.05.2025 (Meeting number: 2025/6). Our investigation relies on opensource data, follows the guidance of ethics committees, and is free from ethical issues and other conflicts of interest. The study was conducted retrospectively and adhered to the data scheme outlined in the approved ethics committee application. Additionally, no changes were made to the study plan or content after ethics committee approval. For these reasons, informed consent was not obtained. All procedures involving human participants performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Decloration of Helsinki and its later amendments or comparable ethical standards. Results Descriptive statistics of the patients in the study are given in Table 1 . The mean age of the patients was 55 ± 20.63 years. 73 (88%) of the patients were hospitalized for 9 days or more, 20 (24.1%) had hypertriglyceridemia, 75 (90.4%) did not consume alcohol and 56 (67.5%) did not have diabetes. 76 (91.6%) of the patients had a BISAP score of 2 or less in the first 24 hours and 72 (86.7%) had an enteral nutrition onset of 72 hours or less. Table 1 Descriptive statistics of the patients in the study (n = 83) Variables n (Number) % (Percent) Age (years)* 55 ± 20,63 Length of Stay > 9 days 10 12 ≤ 9 days 73 88 Hypertriglyceridemia No. 63 75,9 Yes 20 24,1 Alcohol Consumption No. 75 90,4 Yes 8 9,6 Diabetes No. 56 67,5 Yes 27 32,5 BISAP Score ≥ 3 7 8,4 ≤ 2 76 91,6 Enteral Nutrition Initiation > 72 hours 11 13,3 ≤ 72 hours 72 86,7 (*) (mean±standard) (expressed as deviation) When the characteristics of the patients were evaluated according to the start of enteral nutrition, there was a statistically significant difference in the first 24 hours BISAP scores (p < 0.001). In 5 (71.4%) of the patients with a BISAP score of 3 and above, the start of enteral nutrition was over 72 hours. In 70 (92.1%) of those with a BISAP score of 2 and below, the onset of enteral nutrition was 72 hours or less (Table 2 ). Table 2 Evaluation of the characteristics of the patients in the study according to the start of enteral nutrition (n = 83) Variables Enteral Nutrition p > 72 hours ≤ 72 hours n % n % Age (years)* 78 (36–83) 55 (40,25–68,75) 0,104 Duration of Hospitalization - > 9 days 10 100 0 0 ≤ 9 days 1 1,4 72 98,6 Hypertriglyceridemia 0,721 No. 8 12,7 55 87,3 Yes 3 15 17 85 Alcohol Consumption 0,286 No. 9 12 66 88 Yes 2 25 6 75 Diabetes 0,689 No. 8 14,3 48 85,7 Yes 3 11,1 24 88,9 BISAP Score < 0,001 ≥ 3 5 71,4 2 28,6 ≤ 2 6 7,9 70 92,1 (*expressed with median (25th percentile−75th percentile)) . (Mann Whitney U test and Chi−square tests were used) . The effect of BISAP score on enteral nutrition initiation was evaluated by Binary Logistic Regression analysis. A BISAP score of 3 and above significantly (OR = 29.167; CI: 4.634-183.576) increased the duration of enteral nutrition initiation longer than 72 hours in patients (Table 3 ). Table 3 Effect of BISAP score on Enteral Nutrition Initiation (Binary Logistic regression) Variables B Standard Error Wald sd p OR (exp(B)) OR 95% Confidence Interval Alt Top BISAP Score 3,373 0,939 12,915 1 < 0,001 29,167 4,634 183,576 (OR:) (Odds) (Ratio) Discussion In our study, we found that a BISAP score of 3 and above significantly (OR = 29.167; CI: 4.634-183.576) increased the duration of enteral nutrition initiation longer than 72 hours in patients. In the literature, BISAP score ≥ 3 was significantly associated with increased mortality ( 21 ). Compared to other scoring systems used in the evaluation of acute pancreatitis, such as the Ranson criteria and APACHEⅡ, the BISAP scoring system has advantages due to its ease of calculation, the fact that it contains fewer parameters, and that it can only be applied based on clinical information within the first 24 hours after evaluation. The requirement of a 48-hour evaluation to complete the Ranson criteria may result in missing the early treatment period. In addition, the fact that some parameters in the APACHEⅡ system are unrelated to the diagnosis and treatment of acute pancreatitis and that some parameters are difficult to obtain outside of intensive care conditions makes it difficult to use this scoring system in acute pancreatitis ( 22 ). Gao et al. showed that the BISAP score has higher specificity and lower sensitivity for mortality and development of severe acute pancreatitis than the Ranson and APACHEⅡ scores ( 21 ). Although there are studies examining the relationship between early enteral nutrition and length of hospital stay in acute pancreatitis, there are no studies examining the relationship between early enteral nutrition and BISAP score and duration of hospitalization. Since the BISAP score is calculated according to the clinical evaluation in the first 24 hours and its statistical relationship with mortality has been demonstrated in the literature, we thought to reveal the relationship between early enteral nutrition support and duration of hospitalization and its role in evaluating the course, severity and prognosis of acute pancreatitis. In Pascal et al. meta-analysis, 496 of 707 patients with acute pancreatitis received early enteral nutrition support within the first 24 hours and it was found that patients who started early enteral nutrition had a significantly shorter duration of hospitalization compared to patients who started late enteral nutrition ( 18 ). In our study, in addition to the evaluation of the recommendations of the American Gastroenterology Association (AGA) ( 23 ), which associate the initiation of enteral nutrition support within the first 24 hours with fewer complications in mild and moderate pancreatitis, the recommendations in the literature and the duration of enteral nutrition in patients diagnosed with acute pancreatitis were examined and the concept of \"early\" enteral nutrition was established according to the average 72-hour limit. Ramanathan et al. showed that initiation of early enteral nutrition support within the first 48–72 hours in patients diagnosed with acute pancreatitis had positive results in terms of hospitalization, complication rate, prognosis, mortality and cost, but larger randomized studies on this subject are needed ( 24 ). In a meta-analysis by Capursa et al. examining the role of the intestinal barrier in acute pancreatitis, it was demonstrated that fluid loss to the third space and ischemia-reperfusion injury in acute pancreatitis is the beginning of conditions leading to serious systemic complications and that appropriate intravenous fluid resuscitation and early enteral nutrition support limit intestinal damage leading to severe acute pancreatitis ( 13 ). In our study, a statistically significant correlation was found between early enteral nutrition support for ≤ 72 hours and duration of hospitalization for ≤ 9 days in patients with a BISAP score ≤ 2 who underwent the same intravenous fluid resuscitation protocol for mild to moderate acute edematous pancreatitis (p < 0.001). Acute pancreatitis cases with BISAP score ≥ 3 are associated with a 5–20% increase in mortality, especially in these patients, pancreatitis progresses in a severe course and the results of our study reveal that late enteral nutrition is administered in these patients due to the risk of possible complications. There are numerous studies in the literature examining complications that may arise from enteral and parenteral nutrition in cases of acute pancreatitis. It has been shown that the development of septic picture, multiple organ dysfunction syndrome and mortality percentage in patients with acute pancreatitis were significantly less in the enteral nutrition group compared to the parenteral nutrition group ( 25 ). Kusanaga et al. demonstrated that switching to an enteral feeding regimen within 7 days in patients with acute pancreatitis was associated with a 56% reduction in in-hospital mortality rates ( 26 ). In a meta-analysis evaluating the relationship between early and late enteral nutrition provision, it was revealed that early enteral nutrition was associated with a statistically significant shorter duration of hospitalization, especially in acute severe pancreatitis ( 27 ). In summary, our study revealed that early enteral nutrition support in acute edematous pancreatitis did not cause any complications and significantly reduced the hospitalization period, especially in mild to moderate acute pancreatitis ( 28 ). Conclusions Acute pancreatitis is a sudden onset inflammatory disease with an overall mortality rate of 3–5% depending on the severity of the disease ( 29 ). Generally, acute pancreatitis cases progress in a \"mild\" course in clinical follow-up and are self-limiting. Especially in acute pancreatitis cases, it is considered more appropriate to use scoring methods that are easily applicable in clinical follow-up, have a high prognostic value and early treatment opportunities are not missed. >In our study, patients with BISAP score ≥ 3 were associated with an increased mortality risk and it was concluded that enteral nutrition was administered 72 hours late in patients with this course. We think that especially in patients with acute pancreatitis ≤ 72 hours early enteral nutrition will provide a significant reduction in hospitalization time, cost and complications. Declarations Author Contribution M.A.: conceptualization, investigation, methodology, analysis, interpretation of data, writing-original draft preparation, and writing-review and editing; O.S.: contributed to the discussion, writing, review, and editing. A.S.: contributed to the discussion, writing, review, and editing. 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Nutr Clin Pract 34(S1):S7–S12 Wang G, Wen J, Xu L, Zhou S, Gong M, Wen P et al (2013) Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis. J Surg Res 183(2):592–597 Kusanaga M, Tokutsu K, Narita M, Ishikawa S, Muramatsu K, Matsuda S et al (2021) Early Enteral Nutrition is Related to Decreased In-hospital Mortality and Hospitalization in Patients with Acute Pancreatitis: Data from the Japanese Diagnosis Procedure Combination Database. J uoeh 43(3):313–321 Noor M, Iqbal N, Sajid MT, Ahmed M, Afreen K, Qaiser f (2016) Comparison of outcome between early enteral feeding and conventional delayed enteral feeding in acute severe pancreatitis: Outcome of Early Vs Delayed Feeding in Pancreatitis. Pakistan Armed Forces Med J 66(3):377–380 Vaughn VM, Shuster D, Rogers MAM, Mann J, Conte ML, Saint S et al (2017) Early Versus Delayed Feeding in Patients With Acute Pancreatitis: A Systematic Review. Ann Intern Med 166(12):883–892 Metri A, Bush N, Singh VK (2024) Predicting the severity of acute pancreatitis: Current approaches and future directions. Surg Open Sci 19:109–117 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6879794\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":470601391,\"identity\":\"283655e3-211a-420f-969e-a2f1fbf2bc63\",\"order_by\":0,\"name\":\"Murat AY\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYBADHn72BiBlYEGk+gMMDHKSPQdAWiSI12JscCMBxCRCi+6M3IefP9QcTtxw8/nVDT8KJBj427sT8Goxu5FuLHHg2OHEmbdzym72AB0mcebsBgJa0hgkDrAdTuy7nZN2gweoxUAil6AW5h8H/h1ObLh5Ju3mHyK1sEkcbDtsLHCD/dht4mw584zN4mxfOjCQc9huyxhI8BD2y/E05hsV36yBUXn82c03f2zk+Nt78WuBgmYg5jEAsXiIUQ4CdUDM/oBY1aNgFIyCUTDCAABF7E64yGUACgAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Kütahya Sağlık Bilimleri Üniversitesi\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Murat\",\"middleName\":\"\",\"lastName\":\"AY\",\"suffix\":\"\"},{\"id\":470601392,\"identity\":\"cb6aed4d-74d4-4717-861e-9e50ef16739a\",\"order_by\":1,\"name\":\"Osman Saglam\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Afyonkarahisar Sağlık Bilimleri Üniversitesi\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Osman\",\"middleName\":\"\",\"lastName\":\"Saglam\",\"suffix\":\"\"},{\"id\":470601395,\"identity\":\"ceac21dc-885a-4b6b-af89-5431fe1ba574\",\"order_by\":2,\"name\":\"Alper Sari\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Afyonkarahisar Sağlık Bilimleri Üniversitesi\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Alper\",\"middleName\":\"\",\"lastName\":\"Sari\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-06-12 11:23:18\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6879794/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6879794/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":84626616,\"identity\":\"d1980323-937c-40c4-af3c-4846073942c5\",\"added_by\":\"auto\",\"created_at\":\"2025-06-15 06:09:28\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":646207,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6879794/v1/3d042a16-70fa-4c9c-bb4e-18b5d734da43.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Relationship Between Early Enteral Nutrition and BISAP Score with Duration of Hospitalization in Patients with Acute Edematous Pancreatitis\",\"fulltext\":[{\"header\":\"Main Points\",\"content\":\"\\u003cul\\u003e\\n \\u003cli\\u003eEarly initiation of enteral nutrition in patients diagnosed with acute pancreatitis is associated with a reduction in hospitalization duration.\\u003c/li\\u003e\\n \\u003cli\\u003eEarly initiation of enteral nutrition in patients diagnosed with acute pancreatitis is associated with a reduction in disease complications.\\u003c/li\\u003e\\n \\u003cli\\u003eA BISAP score \\u0026gt;3 in patients diagnosed with acute pancreatitis has been found to be associated with failure to provide early enteral nutrition.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\"},{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eAcute pancreatitis is the most commDYon gastroenterologic disease requiring hospitalization. Most patients present with mild acute pancreatitis that is self-limiting and usually resolves within 1 week. Approximately 20% of patients develop moderate to severe acute pancreatitis with pancreatic or peripancreatic tissue necrosis or organ failure or a combination of both clinical pictures and this picture has a mortality rate of 20\\u0026ndash;40% (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe most common presentation of acute pancreatitis is severe upper abdominal pain, and two of the following three criteria must be present for diagnosis: 1.) upper abdominal pain, 2.) serum amylase or lipase (or both) at least three times the upper normal limit, 3.) findings consistent with acute pancreatitis on contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), or abdominal ultrasound (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). Usually necrotizing pancreatitis is detected by imaging 72\\u0026ndash;96 hours after the findings (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eAccording to current guidelines, etiological evaluation should be performed at an early stage (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). In terms of etiology, gallstones (40\\u0026ndash;70%) and alcohol consumption (25\\u0026ndash;35%) are among the most common causes of acute pancreatitis (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). Less common causes include medications, endoscopic retrograde cholangiopancreatography (ERCP), hypercalcemia, hypertriglyceridemia, infections, genetic factors, autoimmune diseases, surgery, and trauma, particularly trauma that damages the pancreatic duct (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). In hypertriglyceridemia, especially triglyceride levels\\u0026thinsp;\\u0026gt;\\u0026thinsp;1000 mg/dL trigger acute pancreatitis attacks, but it has been shown that lower triglyceride levels can also trigger attacks (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eAcute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ), Ranson score and Acute Pancreatitis Bedside Severity Index (BISAP) score; biochemistry tests such as C-reactive protein (CRP) and blood urea nitrogen (BUN) are used in routine practice to determine the severity of acute pancreatitis (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). In line with current recommendations, systemic inflammatory response syndrome (SIRS) or end-organ damage should be assessed for at least 48 hours from the time of presentation in order to predict the course of the disease (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe severity classification of acute pancreatitis is defined as mild, moderate, or severe according to the revised Atlanta classification (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). When evaluated using the revised Atlanta classification criteria, the severity of acute pancreatitis is categorized into three groups based on the presence of organ dysfunction and local (pancreatic or peripancreatic fluid accumulation or portal vein thrombosis) or systemic complications (exacerbation of comorbidities). When there are no local or systemic complications or organ failure, acute pancreatitis is classified as \\u0026ldquo;mild\\u0026rdquo; (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). Conservative treatment is usually sufficient in cases of mild acute pancreatitis. The absence of local or systemic complications and permanent organ failure in acute pancreatitis is categorized as \\u0026ldquo;moderate\\u0026rdquo; (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). The development of permanent single or multiple organ failure in the clinical presentation of acute pancreatitis is classified as \\u0026ldquo;severe\\u0026rdquo; and is associated with a mortality rate of 20\\u0026ndash;40% (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eIn interstitial edema of the pancreas, homogeneous fluid-containing accumulations that develop during the first 4 weeks of the disease are referred to as acute pancreatic or peripancreatic fluid accumulations. These accumulations typically regress without requiring intervention. If these accumulations persist for more than 4 weeks from the onset of the disease, pancreatic pseudocysts may develop. In necrotizing pancreatitis, accumulations that form within the first 4 weeks of the disease onset are referred to as \\u0026ldquo;acute necrotic accumulations.\\u0026rdquo; Acute necrotic collections are usually called \\\"walled-off\\\" necrosis when they mature and encapsulate after the first 4 weeks (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe cornerstones of acute pancreatitis treatment are fluid resuscitation, pain palliation and nutrition. In acute pancreatitis, hypovolemia and end-organ failure may occur with fluid extravasation into the third space accompanied by a systemic immune response. Therefore, appropriate and adequate fluid resuscitation maintains intravascular volume and increases microperfusion and organ perfusion. Favorable effects of optimal fluid resuscitation on clinical outcomes have been demonstrated in the early clinical course of the disease (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). Although there are various publications in the literature regarding optimal fluid resuscitation, current guidelines recommend a heart rate\\u0026thinsp;\\u0026lt;\\u0026thinsp;120/min, mean arterial pressure (MAP): 65\\u0026ndash;85 mm Hg and urine output\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.5-1.0 mL/kg/hour (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). However, multicenter randomized multicenter study by Enrique de-Madaria et al. comparing aggressive (20 mL/kg loading followed by 3 mL/kg maintenance) and moderate (10 mL/kg loading followed by 1.5 mL/kg maintenance) fluid resuscitation with Ringer's lactate solution in patients with acute pancreatitis concluded that early aggressive fluid resuscitation was associated with fluid overload without clinical improvement (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). Fluid resuscitation with Ringer's lactate solution was associated with less SIRS development and lower CRP levels compared to fluid resuscitation with normal saline (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eNutritional support is a cornerstone of treatment in pancreatitis. Optimal nutritional support maintains intestinal barrier function, prevents bacterial translocation and reduces SIRS (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e). Parenteral nutrition is not recommended over enteral nutrition due to increased risk of complications, atrophy of the intestinal mucosa, increased permeability of the intestinal mucosal barrier and mortality (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). Although the role of activation of inflammatory and proteolytic cascades as the underlying mechanism in acute pancreatitis is known, there are studies suggesting that cell signaling is triggered by bacterial infections. As a result of bacterial translocation, macrophages, circulating neutrophils and granulocytes are stimulated and pro-inflammatory cytokines are released. As a result of this imbalance in the inflammatory response, SIRS, infectious pancreatic necrosis and multiple organ failure may develop (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). According to meta-analyses by Marik and Zaloga and McClave et al., early enteral nutrition has been shown to be associated with a reduction in hospitalization and infection-related complications (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). If bacterial translocation can be prevented by maintaining the intestinal barrier with enteral nutrition, early initiation of enteral nutrition is recommended. In summary, early initiation of enteral nutrition in the clinical course of acute pancreatitis has been associated with a reduction in the length of hospitalization (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eAlthough there are many publications on acute pancreatitis in the literature, the majority of these are on fluid management, pain palliation and pancreatitis complications. There are only a limited number of studies in the literature that associate early enteral nutrition in acute pancreatitis with the course of pancreatitis and hospitalization. In particular, there are no studies in the literature on the BISAP score, one of the currently frequently used acute pancreatitis severity scoring indices, and its relationship with the duration of hospitalization and transition to early enteral nutrition. The primary objective of our study was to investigate and demonstrate the contribution of early enteral nutritional support to disease prognosis and length of hospital stay in appropriate cases with a well-defined diagnosis of acute pancreatitis.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003eOur study was conducted cross-sectionally and consists of data from 83 patients diagnosed with acute edematous pancreatitis and followed up at the Internal Medicine Clinic between 01.07.2022-01.07.2024.\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eStudy Design\\u003c/strong\\u003e \\u003cp\\u003eThe patient group included in our study is given below\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients between 18\\u0026ndash;92 years of age who were interned to the Internal Medicine Clinic with a diagnosis of acute edematous pancreatitis,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with no cause of internation other than acute edematous pancreatitis,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients who do not require any treatment other than treatment of acute edematous pancreatitis,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients on the same intravenous fluid protocol,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients who are cooperative, have no mental or psychiatric defect and no diagnosis of psychiatric illness,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients without illicit drug use,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with enteral nutrition adherence,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients who did not require intensive care at any time during the internation process and who were followed up only by the ward team in the Internal Medicine clinic, where treatments prepared according to the protocol in accordance with the algorithm were applied.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe patient group not included in our study is given below:\\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients under 18 years of age and patients over 92 years of age,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with active infection requiring prolonged hospitalization for other etiologies,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients who cannot tolerate active enteral nutrition,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with necrotizing and severe pancreatitis,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with biliary acute pancreatitis,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with cognitive dysfunction,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with a history of non-pancreatitis internation indication,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with autoimmune and chronic pancreatitis,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with pancreatic malignancy,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with cholangitis and cholecystitis,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients on parenteral nutrition,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with acute renal failure diagnoses at and before internationalization,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients diagnosed with chronic renal failure,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients receiving medical treatment causing hyperuricemia,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients whose acute respiratory distress syndrome (ARDS) clinic developed at the time of diagnosis or during ward follow-up,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with active lung infection,\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients on antibiotherapy.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003cp\\u003ePatients with imaging findings suggestive of acute edematous pancreatitis were included in the study. According to the American Gastroenterological Association (AGA) and the revised Atlanta classification (2012) (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e); the diagnosis of acute pancreatitis is based on abdominal pain consistent with acute pancreatitis, at least a threefold increase in serum lipase or amylase, and radiological findings suggestive of acute pancreatitis on ultrasound, magnetic resonance imaging, or computed tomography. Patients with acute edematous pancreatitis who developed necrotizing and severe pancreatitis at diagnosis or follow-up were excluded from the study. Of the 84 patients included in the study, age, internation and externation dates were first determined. The vital follow-up forms of the patients were analyzed after internation. In the follow-up of all patients, Ringer's lactate fluid resuscitation protocol was applied in 5 ml/kg loading and then 1.5 ml/kg maintenance protocol. Afterwards, the comorbidities of the patients were evaluated for hypertriglyceridemia, which is the most common etiology of acute pancreatitis, and alcohol consumption. Biliary pancreatitis cases were excluded because they could not be objectively evaluated due to late transition to enteral nutrition. In order to reveal the statistical relationship of early enteral nutrition support on hospitalization and mortality during the treatment process, patients who received the same infusion protocol and the same intravenous fluid were included in the study. It was determined how many hours after the patients were started on enteral nutrition support.\\u003c/p\\u003e \\u003cp\\u003eThe parameters used in the evaluation of BISAP score (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e) are given below:\\u003c/p\\u003e \\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003eBlood urea nitrogen (BUN)\\u0026thinsp;\\u0026gt;\\u0026thinsp;25 mg/dL\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eSigns of impaired mental function\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;2 Systemic inflammatory response syndrome (SIRS)\\u003csup\\u003e*\\u003c/sup\\u003efindings\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eAge\\u0026thinsp;\\u0026gt;\\u0026thinsp;60\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003ePresence of pleural effusion\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003cdiv class=\\\"BlockQuote\\\"\\u003e \\u003cp\\u003e*: The presence of SIRS signs requires the presence of two of the following findings: body temperature (\\u0026lt;\\u0026thinsp;36\\u0026deg; or \\u0026gt;\\u0026thinsp;38\\u0026deg;), heart rate\\u0026thinsp;\\u0026gt;\\u0026thinsp;90/min, respiratory rate\\u0026thinsp;\\u0026gt;\\u0026thinsp;20/min or PaCO\\u003csub\\u003e2\\u003c/sub\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;32 mm Hg, leukocyte count\\u0026thinsp;\\u0026gt;\\u0026thinsp;12,000 or \\u0026lt;\\u0026thinsp;4,000/mm\\u003csup\\u003e3\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eA BISAP score of \\u0026lt;\\u0026thinsp;2 has been associated with 0-0.5% mortality and \\u0026ge;\\u0026thinsp;3 with 5\\u0026ndash;20% mortality (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eStatistical Analysis\\u003c/strong\\u003e \\u003cp\\u003eDescriptive statistics (arithmetic mean, median, standard deviation, percentage, etc.) were evaluated using IBM SPSS 25v package program. Compliance with normal distribution was checked by Shapiro Wilk test. Chi-Square test was used for intergroup differences of qualitative variables. Mann Whitney U test was used for intergroup differences of quantitative variables that were not normally distributed. The effect of BISAP score on transition to early enteral nutrition regimen was evaluated by Binary Logistic Regression Analysis. P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was used for statistical significance.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003eEthics Committee\\u003c/b\\u003e: The study was approved by Afyonkarahisar Health Sciences University Clinical Research Ethics Committee decisions on 02.05.2025 (Meeting number: 2025/6). Our investigation relies on opensource data, follows the guidance of ethics committees, and is free from ethical issues and other conflicts of interest. The study was conducted retrospectively and adhered to the data scheme outlined in the approved ethics committee application. Additionally, no changes were made to the study plan or content after ethics committee approval. For these reasons, informed consent was not obtained. All procedures involving human participants performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Decloration of Helsinki and its later amendments or comparable ethical standards.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eDescriptive statistics of the patients in the study are given in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. The mean age of the patients was 55\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;20.63 years. 73 (88%) of the patients were hospitalized for 9 days or more, 20 (24.1%) had hypertriglyceridemia, 75 (90.4%) did not consume alcohol and 56 (67.5%) did not have diabetes. 76 (91.6%) of the patients had a BISAP score of 2 or less in the first 24 hours and 72 (86.7%) had an enteral nutrition onset of 72 hours or less.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDescriptive statistics of the patients in the study (n\\u0026thinsp;=\\u0026thinsp;83)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en (Number)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e% (Percent)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAge (years)*\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e55\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;20,63\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eLength of Stay\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;9 days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;9 days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e73\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e88\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHypertriglyceridemia\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e63\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e75,9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24,1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAlcohol Consumption\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e75\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e90,4\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9,6\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDiabetes\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e56\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e67,5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e32,5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eBISAP Score\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8,4\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e76\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e91,6\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEnteral Nutrition Initiation\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;72 hours\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13,3\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;72 hours\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e86,7\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"3\\\"\\u003e\\u003csup\\u003e(*) (mean\\u0026plusmn;standard) (expressed as deviation)\\u003c/sup\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eWhen the characteristics of the patients were evaluated according to the start of enteral nutrition, there was a statistically significant difference in the first 24 hours BISAP scores (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). In 5 (71.4%) of the patients with a BISAP score of 3 and above, the start of enteral nutrition was over 72 hours. In 70 (92.1%) of those with a BISAP score of 2 and below, the onset of enteral nutrition was 72 hours or less (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eEvaluation of the characteristics of the patients in the study according to the start of enteral nutrition (n\\u0026thinsp;=\\u0026thinsp;83)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c5\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eEnteral Nutrition\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003ep\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;72 hours\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;72 hours\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e%\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003en\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e%\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAge (years)*\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e78 (36\\u0026ndash;83)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003e55 (40,25\\u0026ndash;68,75)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0,104\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDuration of Hospitalization\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;9 days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e100\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;9 days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1,4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e98,6\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHypertriglyceridemia\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0,721\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12,7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e55\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e87,3\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e85\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAlcohol Consumption\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0,286\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e66\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e88\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e75\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDiabetes\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e0,689\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14,3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e85,7\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11,1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e88,9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eBISAP Score\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;0,001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e71,4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e28,6\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7,9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e70\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e92,1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003csup\\u003e(*expressed with median (25th percentile\\u0026minus;75th percentile))\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003csup\\u003e(Mann Whitney U test and Chi\\u0026minus;square tests were used)\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eThe effect of BISAP score on enteral nutrition initiation was evaluated by Binary Logistic Regression analysis. A BISAP score of 3 and above significantly (OR\\u0026thinsp;=\\u0026thinsp;29.167; CI: 4.634-183.576) increased the duration of enteral nutrition initiation longer than 72 hours in patients (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eEffect of BISAP score on Enteral Nutrition Initiation (Binary Logistic regression)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"9\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eB\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eStandard Error\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eWald\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003esd\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ep\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eOR (exp(B))\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e \\u003cp\\u003eOR 95% Confidence Interval\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAlt\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTop\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBISAP Score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3,373\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0,939\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12,915\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;0,001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e29,167\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e4,634\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e183,576\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"9\\\"\\u003e\\u003csup\\u003e(OR:) (Odds) (Ratio)\\u003c/sup\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn our study, we found that a BISAP score of 3 and above significantly (OR\\u0026thinsp;=\\u0026thinsp;29.167; CI: 4.634-183.576) increased the duration of enteral nutrition initiation longer than 72 hours in patients. In the literature, BISAP score\\u0026thinsp;\\u0026ge;\\u0026thinsp;3 was significantly associated with increased mortality (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). Compared to other scoring systems used in the evaluation of acute pancreatitis, such as the Ranson criteria and APACHEⅡ, the BISAP scoring system has advantages due to its ease of calculation, the fact that it contains fewer parameters, and that it can only be applied based on clinical information within the first 24 hours after evaluation. The requirement of a 48-hour evaluation to complete the Ranson criteria may result in missing the early treatment period. In addition, the fact that some parameters in the APACHEⅡ system are unrelated to the diagnosis and treatment of acute pancreatitis and that some parameters are difficult to obtain outside of intensive care conditions makes it difficult to use this scoring system in acute pancreatitis (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). Gao et al. showed that the BISAP score has higher specificity and lower sensitivity for mortality and development of severe acute pancreatitis than the Ranson and APACHEⅡ scores (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eAlthough there are studies examining the relationship between early enteral nutrition and length of hospital stay in acute pancreatitis, there are no studies examining the relationship between early enteral nutrition and BISAP score and duration of hospitalization. Since the BISAP score is calculated according to the clinical evaluation in the first 24 hours and its statistical relationship with mortality has been demonstrated in the literature, we thought to reveal the relationship between early enteral nutrition support and duration of hospitalization and its role in evaluating the course, severity and prognosis of acute pancreatitis. In Pascal et al. meta-analysis, 496 of 707 patients with acute pancreatitis received early enteral nutrition support within the first 24 hours and it was found that patients who started early enteral nutrition had a significantly shorter duration of hospitalization compared to patients who started late enteral nutrition (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). In our study, in addition to the evaluation of the recommendations of the American Gastroenterology Association (AGA) (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e), which associate the initiation of enteral nutrition support within the first 24 hours with fewer complications in mild and moderate pancreatitis, the recommendations in the literature and the duration of enteral nutrition in patients diagnosed with acute pancreatitis were examined and the concept of \\\"early\\\" enteral nutrition was established according to the average 72-hour limit. Ramanathan et al. showed that initiation of early enteral nutrition support within the first 48\\u0026ndash;72 hours in patients diagnosed with acute pancreatitis had positive results in terms of hospitalization, complication rate, prognosis, mortality and cost, but larger randomized studies on this subject are needed (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e). In a meta-analysis by Capursa et al. examining the role of the intestinal barrier in acute pancreatitis, it was demonstrated that fluid loss to the third space and ischemia-reperfusion injury in acute pancreatitis is the beginning of conditions leading to serious systemic complications and that appropriate intravenous fluid resuscitation and early enteral nutrition support limit intestinal damage leading to severe acute pancreatitis (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e). In our study, a statistically significant correlation was found between early enteral nutrition support for \\u0026le;\\u0026thinsp;72 hours and duration of hospitalization for \\u0026le;\\u0026thinsp;9 days in patients with a BISAP score\\u0026thinsp;\\u0026le;\\u0026thinsp;2 who underwent the same intravenous fluid resuscitation protocol for mild to moderate acute edematous pancreatitis (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Acute pancreatitis cases with BISAP score\\u0026thinsp;\\u0026ge;\\u0026thinsp;3 are associated with a 5\\u0026ndash;20% increase in mortality, especially in these patients, pancreatitis progresses in a severe course and the results of our study reveal that late enteral nutrition is administered in these patients due to the risk of possible complications.\\u003c/p\\u003e \\u003cp\\u003eThere are numerous studies in the literature examining complications that may arise from enteral and parenteral nutrition in cases of acute pancreatitis. It has been shown that the development of septic picture, multiple organ dysfunction syndrome and mortality percentage in patients with acute pancreatitis were significantly less in the enteral nutrition group compared to the parenteral nutrition group (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). Kusanaga et al. demonstrated that switching to an enteral feeding regimen within 7 days in patients with acute pancreatitis was associated with a 56% reduction in in-hospital mortality rates (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e). In a meta-analysis evaluating the relationship between early and late enteral nutrition provision, it was revealed that early enteral nutrition was associated with a statistically significant shorter duration of hospitalization, especially in acute severe pancreatitis (\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). In summary, our study revealed that early enteral nutrition support in acute edematous pancreatitis did not cause any complications and significantly reduced the hospitalization period, especially in mild to moderate acute pancreatitis (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e).\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eAcute pancreatitis is a sudden onset inflammatory disease with an overall mortality rate of 3\\u0026ndash;5% depending on the severity of the disease (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e). Generally, acute pancreatitis cases progress in a \\\"mild\\\" course in clinical follow-up and are self-limiting. Especially in acute pancreatitis cases, it is considered more appropriate to use scoring methods that are easily applicable in clinical follow-up, have a high prognostic value and early treatment opportunities are not missed. \\u0026gt;In our study, patients with BISAP score\\u0026thinsp;\\u0026ge;\\u0026thinsp;3 were associated with an increased mortality risk and it was concluded that enteral nutrition was administered 72 hours late in patients with this course. We think that especially in patients with acute pancreatitis\\u0026thinsp;\\u0026le;\\u0026thinsp;72 hours early enteral nutrition will provide a significant reduction in hospitalization time, cost and complications.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eM.A.: conceptualization, investigation, methodology, analysis, interpretation of data, writing-original draft preparation, and writing-review and editing; O.S.: contributed to the discussion, writing, review, and editing. A.S.: contributed to the discussion, writing, review, and editing. All the authors have read and agreed to the published version of the manuscript.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eSchepers NJ, Bakker OJ, Besselink MG, Ahmed Ali U, Bollen TL, Gooszen HG et al (2019) Impact of characteristics of organ failure and infected necrosis on mortality in necrotizing pancreatitis. Gut 68(6):1044\\u0026ndash;1051\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003evan Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver AM et al (2011) A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 141(4):1254\\u0026ndash;1263\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eIAP/APA evidence (2013) -based guidelines for the management of acute pancreatitis. Pancreatology 13(4 Suppl 2):e1\\u0026ndash;15\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRoberts SE, Morrison-Rees S, John A, Williams JG, Brown TH, Samuel DG (2017) The incidence and aetiology of acute pancreatitis across Europe. Pancreatology 17(2):155\\u0026ndash;165\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTenner S, Baillie J, DeWitt J, Vege SS (2013) American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. ;108(9):1400-15; 16\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNawaz H, Koutroumpakis E, Easler J, Slivka A, Whitcomb DC, Singh VP et al (2015) Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis. Am J Gastroenterol 110(10):1497\\u0026ndash;1503\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMounzer R, Langmead CJ, Wu BU, Evans AC, Bishehsari F, Muddana V et al (2012) Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology 142(7):1476\\u0026ndash;1482 quiz e15-6\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eArvanitakis M, Dumonceau JM, Albert J, Badaoui A, Bali MA, Barthet M et al (2018) Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 50(5):524\\u0026ndash;546\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBanks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al (2013) Classification of acute pancreatitis\\u0026ndash;2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102\\u0026ndash;111\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBuxbaum JL, Quezada M, Da B, Jani N, Lane C, Mwengela D et al (2017) Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. Am J Gastroenterol 112(5):797\\u0026ndash;803\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ede-Madaria E, Buxbaum JL, Maisonneuve P, Paredes AGGd, Zapater P, Guilabert L et al (2022) Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med 387(11):989\\u0026ndash;1000\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ede-Madaria E, Herrera-Marante I, Gonz\\u0026aacute;lez-Camacho V, Bonjoch L, Quesada-V\\u0026aacute;zquez N, Almenta-Saavedra I et al (2018) Fluid resuscitation with lactated Ringer's solution vs normal saline in acute pancreatitis: A triple-blind, randomized, controlled trial. United Eur Gastroenterol J 6(1):63\\u0026ndash;72\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCapurso G, Zerboni G, Signoretti M, Valente R, Stigliano S, Piciucchi M et al (2012) Role of the gut barrier in acute pancreatitis. J Clin Gastroenterol 46(Suppl):S46\\u0026ndash;51\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLi W, Liu J, Zhao S, Li J (2018) Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis: a meta-analysis. J Int Med Res 46(9):3948\\u0026ndash;3958\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSoares R, Chini G, Dutra S (1988) Enteral Nutrition in patients with Acute Pancreatitis. Nutrition 4:86\\u0026ndash;89\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMarik PE, Zaloga GP (2004) Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ 328(7453):1407\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcClave SA, Chang WK, Dhaliwal R, Heyland DK (2006) Nutrition support in acute pancreatitis: a systematic review of the literature. JPEN J Parenter Enter Nutr 30(2):143\\u0026ndash;156\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePascal M, Magier S, Nawaz A, Muniraj T, Hung KW (2022) S13 Early Feeding Rates in Acute Pancreatitis Is Associated With Decreased Length of Hospitalization. Official J Am Coll Gastroenterol | ACG 117(10S):e12\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBanks PA, Freeman ML (2006) Practice guidelines in acute pancreatitis. Am J Gastroenterol 101(10):2379\\u0026ndash;2400\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA (2008) The early prediction of mortality in acute pancreatitis: a large population-based study. Gut 57(12):1698\\u0026ndash;1703\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGao W, Yang HX, Ma CE (2015) The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis: A Systematic Review and Meta-Analysis. PLoS ONE 10(6):e0130412\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChauhan S, Forsmark CE (2010) The difficulty in predicting outcome in acute pancreatitis. Am J Gastroenterol 105(2):443\\u0026ndash;445\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCrockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN, Crockett S et al (2018) American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology 154(4):1096\\u0026ndash;1101\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRamanathan M, Aadam AA (2019) Nutrition Management in Acute Pancreatitis. Nutr Clin Pract 34(S1):S7\\u0026ndash;S12\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWang G, Wen J, Xu L, Zhou S, Gong M, Wen P et al (2013) Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis. J Surg Res 183(2):592\\u0026ndash;597\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKusanaga M, Tokutsu K, Narita M, Ishikawa S, Muramatsu K, Matsuda S et al (2021) Early Enteral Nutrition is Related to Decreased In-hospital Mortality and Hospitalization in Patients with Acute Pancreatitis: Data from the Japanese Diagnosis Procedure Combination Database. J uoeh 43(3):313\\u0026ndash;321\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNoor M, Iqbal N, Sajid MT, Ahmed M, Afreen K, Qaiser f (2016) Comparison of outcome between early enteral feeding and conventional delayed enteral feeding in acute severe pancreatitis: Outcome of Early Vs Delayed Feeding in Pancreatitis. Pakistan Armed Forces Med J 66(3):377\\u0026ndash;380\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVaughn VM, Shuster D, Rogers MAM, Mann J, Conte ML, Saint S et al (2017) Early Versus Delayed Feeding in Patients With Acute Pancreatitis: A Systematic Review. Ann Intern Med 166(12):883\\u0026ndash;892\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMetri A, Bush N, Singh VK (2024) Predicting the severity of acute pancreatitis: Current approaches and future directions. Surg Open Sci 19:109\\u0026ndash;117\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"acute pancreatitis, early enteral feeding, BISAP score, hospitalization\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6879794/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6879794/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eObjective: \\u003c/strong\\u003eThe main objective of our study was to examine and demonstrate the contribution of early enteral nutrition support to the disease prognosis and duration of hospitalization, in appropriate cases diagnoes with well-defined acute pancreatitis.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMaterials and Methods: \\u003c/strong\\u003eThis cross-sectional study included 84 patients admitted to the Internal Medicine clinic with a diagnosis of acute edematous pancreatitis. In order to reveal the statistical relationship of early enteral nutrition support on hospitalization and mortality during the treatment process, patients who received the same infusion protocol and the same intravenous fluid were included in the study. The number of hours after the patients were started on enteral nutrition support was determined.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults: \\u003c/strong\\u003eThe effect of BISAP score on the initiation of enteral nutrition was evaluated by Binary Logistic Regression analysis. A BISAP score of 3 and above significantly (OR=29.167; CI: 4.634-183.576) increased the duration of enteral nutrition initiation longer than 72 hours.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDiscussion\\u003c/strong\\u003e: There are no studies on the relationship between early enteral nutrition and BISAP score and duration of hospitalization. Since the BISAP score is calculated according to the clinical evaluation in the first 24 hours and its statistical relationship with mortality has been demonstrated in the literature, we thought to reveal the relationship between early enteral nutrition support and hospitalization duration in the evaluation of the course, severity and prognosis of acute pancreatitis.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions: \\u003c/strong\\u003eWe think that early enteral nutrition ≤72 hours in patients with acute pancreatitis will provide a significant reduction in hospitalization time and complications.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Relationship Between Early Enteral Nutrition and BISAP Score with Duration of Hospitalization in Patients with Acute Edematous Pancreatitis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-06-13 03:07:42\",\"doi\":\"10.21203/rs.3.rs-6879794/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"c7b83ab2-c38a-414d-9149-ae74f87ec827\",\"owner\":[],\"postedDate\":\"June 13th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-08-13T13:38:38+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-06-13 03:07:42\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6879794\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6879794\",\"identity\":\"rs-6879794\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}