Effect of aggressive versus conservative hydration for early phase of acute pancreatitis in adult patients: A meta-analysis of 3,127 cases |
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| Institution: | 1. Department of Intensive Care Unit, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, No. 3 Shajing Street, Baoan District, Shenzhen, 518000, Guangdong Province, China;2. The Acupuncture Rehabilitation Clinical College of Guangzhou University of Chinese Medicine, No. 12 Airport Road, Baiyun District, Guangzhou, 510000, Guangdong Province, China;1. Department of Pathology, Incheon St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;3. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;4. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;1. Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China;2. The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, PR China;3. Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China;4. Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences & PUMC, Beijing, PR China;5. Qinghai University Affiliated Hospital, PR China;1. Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;2. Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom;3. Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA |
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| Abstract: | BackgroundThe advantages of aggressive hydration compared to conservative hydration within 24 h for acute pancreatitis (AP) remain controversial in adult patients. A meta-analysis was undertaken to investigate whether aggressive strategies are more beneficial.MethodsWe searched (on February 1, 2021) PubMed, Embase, and the Cochrane Library for eligible trials that assessed the two therapies and performed a meta-analysis. The primary endpoint was in-hospital mortality. Secondary outcomes were adverse events (e.g., renal failure and pancreatic necrosis) within 24 h of treatment.ResultsFive randomized controlled trials and 8 observational trials involving 3127 patients were identified. Patients with severe pancreatitis showed significant difference of in-hospital mortality (OR 1.75; 95% CI 1.32–2.33) in aggressive hydration group, which were less susceptible to study type and age. Patients with severe pancreatitis were likely to develop respiratory failure (OR 5.08; 95% CI 2.31–11.15), persistent SIRS (OR 2.83; 95% CI 1.58–5.04), renal failure (OR 2.58; 95% CI 1.90–3.50) with significant difference. A longer hospital stay was observed in patients with severe pancreatitis (WMD 7.61; 95% CI 5.51–9.71; P < 0.05) in the aggressive hydration group. Higher incidence of pancreatic necrosis (OR 2.34; 95% CI 1.60–3.42; P < 0.05) was major susceptible to observational studies, old patients and mild pancreatitis.ConclusionsCompared to conservative hydration, aggressive hydration increases in-hospital mortality and the incidence of renal failure, pancreatic necrosis with relatively strong evidence. Further investigation should be designed with a definitive follow-up period and therapeutic goals to address reverse causation bias. |
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| Keywords: | Aggressive hydration Acute pancreatitis Mortality Adverse events Meta-analysis |
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