Original Contribution | Published:

Pancreas and Biliary Tract

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

The American Journal of Gastroenterology volume 106, pages 18431850 (2011) | Download Citation

Abstract

OBJECTIVES:

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.

METHODS:

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).

RESULTS:

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.

CONCLUSIONS:

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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References

  1. 1.

    , , et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol 2006;101:2128–2138.

  2. 2.

    , , . The changing character of acute pancreatitis: epidemiology, etiology, and prognosis. Curr Gastroenterol Rep 2009;11:97–103.

  3. 3.

    , , et al. Digestive and liver diseases statistics, 2004. Gastroenterology 2004;126:1448–1453.

  4. 4.

    , . AGA Institute Technical Review on Acute Pancreatitis. Gastroenterology 2007;132:2022–2044.

  5. 5.

    , , et al. Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from a meta-analysis of randomized controlled trials. Am J Gastroenterol 2008;103:104–110.

  6. 6.

    , , et al. Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials. Ann Surg 2008;247:250–257.

  7. 7.

    . Initial management of acute pancreatitis: critical issues during the first 72 hours. Am J Gastroenterol 2004;99:2489–2494.

  8. 8.

    , . Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101:2379–2400.

  9. 9.

    . Clinical practice. Acute pancreatitis. N Engl J Med 2006;354:2142–2150.

  10. 10.

    , , et al. Acute pancreatitis: bench to the bedside. Gastroenterology 2007;132:1127–1151.

  11. 11.

    , , et al. Recommendations of the Spanish Biliopancreatic Club for the Treatment of Acute Pancreatitis. Consensus development conference.. Gastroenterol Hepatol 2008;31:366–387.

  12. 12.

    , , et al. Fluid resuscitation in acute pancreatitis. Clin Gastroenterol Hepatol 2008;6:1070–1076.

  13. 13.

    , , et al. Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol 1998;93:2130–2134.

  14. 14.

    , , et al. Hemoconcentration: an early marker of severe and/or necrotizing pancreatitis? A critical appraisal. Am J Gastroenterol 2001;96:2081–2085.

  15. 15.

    , . Admission hematocrit: a simple, useful and early predictor of severe pancreatitis. Dig Dis Sci 2004;49:1946–1952.

  16. 16.

    , , . Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas 2000;20:367–372.

  17. 17.

    , , et al. Early changes in blood urea nitrogen predict mortality in acute pancreatitis. Gastroenterology 2009;137:129–135.

  18. 18.

    , , et al. Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis? Pancreatology 2002;2:104–107.

  19. 19.

    , , et al. Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: what have we learned and how can we do better? Clin Nutr 2006;25:497–504.

  20. 20.

    , , et al. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology 2009;9:770–776.

  21. 21.

    , , et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.

  22. 22.

    , , et al. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 1995;273:117–123.

  23. 23.

    . A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg 1993;128:586–590.

  24. 24.

    , , et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354:2564–2575.

  25. 25.

    , , et al. Intra-abdominal hypertension in patients with severe acute pancreatitis. Crit Care 2005;9:R452–R457.

  26. 26.

    , . Intra-abdominal hypertension in acute pancreatitis. World J Surg 2009;33:1128–1133.

  27. 27.

    , , et al. Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl) 2009;122:169–173.

  28. 28.

    , , et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373–1379.

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Author information

Affiliations

  1. Pancreatic Unit, Hospital General Universitario de Alicante, Alicante, Spain

    • Enrique de-Madaria
    • , Gema Soler-Sala
    • , Inmaculada Lopez-Font
    • , Juan Martínez
    • , Laura Gómez-Escolar
    • , Laura Sempere
    • , Cristina Sánchez-Fortún
    •  & Miguel Pérez-Mateo
  2. Department of Preventive Medicine, Hospital General Universitario de Alicante, Alicante, Spain

    • José Sánchez-Payá

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Competing interests

Guarantor of the article: Enrique de-Madaria, MD.

Specific author contributions: Enrique de-Madaria: study design, data collection, data analysis, and manuscript preparation; José Sánchez-Payá: statistical analysis; Gema Soler-Sala: data analysis and data collection; Inmaculada Lopez-Font, Laura Gómez-Escolar, Laura Sempere, and Cristina Sánchez-Fortún: data collection; Juan Martínez and Miguel Pérez-Mateo: critical revision of the paper.

Financial support: None.

Potential competing interests: None.

Corresponding author

Correspondence to Enrique de-Madaria.

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DOI

https://doi.org/10.1038/ajg.2011.236

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg

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