Influence of Fluid Therapy on the Prognosis of Acute Pancreatitis: A Prospective Cohort Study

Pancreatic Unit, Hospital General Universitario de Alicante, Spain.
The American Journal of Gastroenterology (Impact Factor: 10.76). 08/2011; 106(10):1843-50. DOI: 10.1038/ajg.2011.236
Source: PubMed


Although aggressive fluid therapy during the first days of hospitalization is recommended by most guidelines and reviews on acute pancreatitis (AP), this recommendation is not supported by any direct evidence. We aimed to evaluate the association between the amount of fluid administered during the initial 24 h of hospitalization and the incidence of organ failure (OF), local complications, and mortality.
This was a prospective cohort study. We included consecutive adult patients admitted with AP. Local complications and OF were defined according to the Atlanta Classification. Persistent OF was defined as OF of >48-h duration. Patients were divided into three groups according to the amount of fluid administered during the initial 24 h: group A: <3.1 l (less than the first quartile), group B: 3.1-4.1 l (between the first and third quartiles), and group C: >4.1 l (more than the third quartile).
A total of 247 patients were analyzed. Administration of >4.1 l during the initial 24 h was significantly and independently associated with persistent OF, acute collections, respiratory insufficiency, and renal insufficiency. Administration of <3.1 l during the initial 24 h was not associated with OF, local complications, or mortality. Patients who received between 3.1 and 4.1 l during the initial 24 h had an excellent outcome.
In our study, administration of a small amount of fluid during the initial 24 h was not associated with a poor outcome. The need for a great amount of fluid during the initial 24 h was associated with a poor outcome; therefore, this group of patients must be carefully monitored.

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    • "The severity of the disease can also be established by multifactorial scores (Ranson [60], Glasgow [61], Apache II [62]) at the point of admission and in the first 24-48 hours, by unifactorial markers (PCR, TAP [63], Procalcitonin [64], Hct), and subsequently by means of imaging (Balthazar score and CTSI). In severe or early severe acute pancreatitis the initial therapeutic approach, as mentioned, is based on aggressive fluid resuscitation, invasive hemodynamic monitoring, intensive care, correction of hypoxaemia, and enteral nutrition [65]. Next, the cornerstone of the therapeutic programme required, in the opinion of many authors [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48], an urgent ERCP with endoscopic sphincterotomy. "

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    • "This observation is supported by a meta-analysis which demonstrated in both RCTs and cohort studies that a conservative fluid strategy was associated with a lower mortality in trauma patients [68]. Similarly, an aggressive fluid strategy in the resuscitation of patients with acute pancreatitis has been associated with an increased risk of complications [69]. "
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