Influence of Fluid Therapy on the Prognosis of Acute Pancreatitis: A Prospective Cohort Study
ABSTRACT 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.
- SourceAvailable from: Vincenzo Neri
Acute and Chronic Pancreatitis, Edited by Luis Rodrigo, 01/2015: chapter 7: pages 121-152; INTECH., ISBN: 978-953-51-2026-1
- "The severity of the disease can also be established by multifactorial scores (Ranson , Glasgow , Apache II ) at the point of admission and in the first 24-48 hours, by unifactorial markers (PCR, TAP , Procalcitonin , 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 . Next, the cornerstone of the therapeutic programme required, in the opinion of many authors           , an urgent ERCP with endoscopic sphincterotomy. "
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ABSTRACT: Acute pancreatitis (AP) in children is an increasingly recognised clinical entity notably different from the adults with respect to incidence, aetiology, severity and outcome. Yet our current understanding and approach to the management of paediatric pancreatitis is based almost entirely on adult studies. Acute recurrent pancreatitis (ARP) in children is more likely associated with various genetic factors, some of which have been relatively well characterised and others are in an evolving phase. The aim of this review is to summarise current knowledge, highlight any recent advances and contrast the paediatric and adult forms of this condition.Pancreatology 07/2013; 13(4):429-35. DOI:10.1016/j.pan.2013.06.005 · 2.50 Impact Factor
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ABSTRACT: Die akute Pankreatitis ist ein häufiges und klinisch eindrucksvolles Krankheitsbild. Eine spezifische Therapie existiert nicht. Ziel der ärztlichen Maßnahmen ist die Linderung der Symptome und die Verhinderung von Komplikationen. In den letzten Jahren gab es einen erheblichen Zugewinn an Wissen über die korrekte Behandlung der Erkrankung. Neben einer Spezifizierung der Empfehlungen zur Flüssigkeitstherapie betrifft das vor allem die Ernährungstherapie, die Ökonomisierung der Bildgebung, den Einsatz von Antibiotika bei Komplikationen und vor allem Maßnahmen zur Entlastung von großen oder infizierten Nekrosen. Der derzeitige Stand der Erkenntnisse wird im Beitrag zusammengefasst.09/2012; 108(6). DOI:10.1007/s00063-012-0154-6