Fluid resuscitation in the early management of acute pancreatitis: a five-year retrospective observational study

Early intravenous fluid (IVF) resuscitation is critical to the management of acute pancreatitis (AP). Nonetheless, the optimal fluid type, infusion rate, and volume remain subjects of debate in clinical practice. This study aimed to investigate the dosage and rate of early intravenous fluid (IVF) resuscitation on the prognosis and complications of AP.

This study included patients diagnosed with AP who were admitted to Zhongshan Hospital, Fudan University, between December 1, 2018, and December 1, 2022. Patients were classified into mild and non-mild groups according to the Atlanta criteria. Clinical data, including the dosage of IVF resuscitation within 24 h after admission, complications, and clinical prognosis, were collected. Systemic complications, including in-hospital mortality, endotracheal intubation, renal replacement therapy, and secondary infection, were defined as composite endpoint 1. Local complications, including the peripancreatic fluid accumulation, local drainage, and pseudocyst formation, were defined as composite endpoint 2. Risk factors associated with these endpoints were identified via multivariate logistic regression.

A total of 527 AP patients were enrolled. The IVF dosage in the first 24 h was significantly higher in the non-mild group (62.48 [54.06, 72.99] mL/kg vs. 54.21 [45.88, 62.23] mL/kg, P<0.001) compared with the mild group. Sequential Organ Failure Assessment (SOFA) and the dosage of IVF were identified as independent risk factors for both systemic complications (SOFA: OR 2.477 [95%CI 1.464-4.189], P<0.001; IVF: OR 1.058 [95%CI 1.015-1.102], P=0.0082) and local complications (SOFA: OR 1.545 [95%CI 1.266-1.887], P<0.001; IVF: OR 1.035 [95%CI 1.017-1.053], P<0.001). According to the ROC curve, the optimal cutoff value for the dose of IVF resuscitation was 69.89 mL/kg (2.9 mL/[kg·h]). Further stratified analysis revealed stepwise increases in IVF rates across SOFA groups (SOFA<2, SOFA 2-4, and SOFA>4).

The early IVF resuscitation was associated with both systemic and local complications of AP, supporting a shift from "empirical" to "precisely prescribed" IVF therapy in the managment of AP.