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Early fluid resuscitation reduces morbidity among patients with acute pancreatitis
Matthew G Warndorf1, Jane T Kurtzman, Michael J Bartel
1Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Insights
Early fluid resuscitation significantly reduces systemic inflammatory response syndrome (SIRS) and organ failure in acute pancreatitis patients. These benefits are most notable in those with interstitial pancreatitis upon admission.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Clinical Research
Background:
- Acute pancreatitis management guidelines recommend early fluid resuscitation.
- The precise impact of early fluid resuscitation on patient outcomes remains underquantified.
- This study aimed to evaluate the association between early fluid resuscitation and outcomes in acute pancreatitis.
Purpose of the Study:
- To investigate the association between early fluid resuscitation and patient outcomes in acute pancreatitis.
- To quantify the impact of early fluid resuscitation on key clinical endpoints.
- To identify patient subgroups that may benefit most from early fluid resuscitation.
Main Methods:
- Retrospective analysis of non-transfer patients admitted with acute pancreatitis (1985-2009).
- Stratification into early (≥1/3 total 72-hr volume within 24 hrs) and late (≤1/3 total 72-hr volume within 24 hrs) resuscitation groups.
- Primary outcomes included systemic inflammatory response syndrome (SIRS), organ failure, and mortality.
Main Results:
- Early resuscitation significantly decreased SIRS incidence at 24, 48, and 72 hours (P < .05).
- Reduced organ failure at 72 hours (5% vs 10%, P < .05) and lower ICU admission rates (6% vs 17%, P < .001) were observed with early resuscitation.
- Early fluid resuscitation was associated with a shorter hospital stay (8 vs 11 days, P = .01).
Conclusions:
- Early fluid resuscitation in acute pancreatitis is linked to a reduced incidence of SIRS and organ failure.
- The positive effects of early fluid resuscitation were more pronounced in patients with interstitial pancreatitis compared to severe pancreatitis.
- These findings support the prompt administration of fluids in acute pancreatitis management.
Background & Aims:
Early fluid resuscitation is recommended to reduce morbidity and mortality among patients with acute pancreatitis, although the impact of this intervention has not been quantified. We investigated the association between early fluid resuscitation and outcome of patients admitted to the hospital with acute pancreatitis.
Methods:
Nontransfer patients admitted to our center with acute pancreatitis from 1985-2009 were identified retrospectively. Patients were stratified into groups on the basis of early (n = 340) or late resuscitation (n = 94). Early resuscitation was defined as receiving ≥one-third of the total 72-hour fluid volume within 24 hours of presentation, whereas late resuscitation was defined as receiving ≤one-third of the total 72-hour fluid volume within 24 hours of presentation. The primary outcomes were frequency of systemic inflammatory response syndrome (SIRS), organ failure, and death.
Results:
Early resuscitation was associated with decreased SIRS, compared with late resuscitation, at 24 hours (15% vs 32%, P = .001), 48 hours (14% vs 33%, P = .001), and 72 hours (10% vs 23%, P = .01), as well as reduced organ failure at 72 hours (5% vs 10%, P < .05), a lower rate of admission to the intensive care unit (6% vs 17%, P < .001), and a reduced length of hospital stay (8 vs 11 days, P = .01). Subgroup analysis demonstrated that these benefits were more pronounced in patients with interstitial rather than severe pancreatitis at admission.
Conclusions:
In patients with acute pancreatitis, early fluid resuscitation was associated with reduced incidence of SIRS and organ failure at 72 hours. These effects were most pronounced in patients admitted with interstitial rather than severe disease.
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