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Aggressive fluid administration may increase survival in severe acute pancreatitis

15 May 2018

Administration of a large fluid volume within the first 24 hours appears to provide survival benefits to patients with severe acute pancreatitis (SAP), as reported in a study.

Researchers looked at 1,097 adult SAP patients who were administered fluid at a volume of either <6,000 or ≥6,000 mL in the first 24 hours. The primary endpoint was in-hospital mortality, while secondary endpoints included the incidence of pancreatic infection and the need for surgical intervention.

Overall, the mean fluid volume administered was 5,618 mL, and overall in-hospital mortality was 12.3 percent. Univariable logistic regression analysis showed mortality to be significantly higher in the fluid ≥6000 mL group than in the <6000 mL group (15.9 percent vs 10.3 percent; p<0.05). When analysis was adjusted for confounding factors, administration of ≥6,000 mL of fluid within the first 24 hours was associated with a significant reduction in mortality (odds ratio, 0.58; p<0.05).

The ≥6,000 mL group also had significantly higher incidence of pancreatic infection (p<0.001) and need for surgical intervention (p<0.001). However, the administered fluid volume was associated with neither pancreatic infection nor the need for surgical intervention.

Although the group of patients who were given ≥6000 mL of fluid had higher severity, morbidity and mortality than the group given <6,000 mL of fluid, the former had a lower risk of mortality when adjusted for severity, researchers noted.

According to the American College of Gastroenterology, fluid needs of 5 L daily are not uncommon in severe acute pancreatitis. Guidelines recommend aggressive fluid resuscitation (defined as 250–500 mL/hour) for all patients unless cardiovascular or renal comorbidities exist, as well as state that early aggressive intravenous hydration is most beneficial during the first 12–24 hours. The Japanese guideline also recommends rapid fluid resuscitation (150–600 mL/h) to treat shock and dehydration in acute pancreatitis patients. [Am J Gastroenterol 2013;108:1400-1415; J Hepatobiliary Pancreat Sci 2015;22:405-432; Gastroenterology 2007;132:2022-2044]

Although the universal cutoff value (eg, 6,000 mL) for all patients cannot be determined, certain patients may require a large volume infusion to improve outcomes. The present data suggest that large volume resuscitation is a critical part of the management of patients with severe pancreatitis, researchers said.

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