Faster Rate of Initial Fluid Resuscitation in Severe Acute Pancreatitis Diminishes In-Hospital Mortality |
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| Authors: | Timothy B. Gardner Santhi Swaroop Vege Suresh T. Chari Bret T. Petersen Mark D. Topazian Jonathan E. Clain Randall K. Pearson Michael J. Levy Michael G. Sarr |
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| Affiliation: | 1. Miles and Shirley Fiterman Center for Digestive Diseases, Lebanon, N.H., USA;2. Department of General Surgery, Mayo Clinic Rochester, Rochester, Minn., Lebanon, N.H., USA;3. Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, N.H., USA;1. Department of Surgery, University of Auckland, Auckland, New Zealand;2. Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, USA;1. Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China;2. Department of Emergency, Liaocheng People''s Hospital, Liaocheng 252000, Shandong Province, China;3. Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China;1. Saint Louis University Center for Outcomes Research (SLUCOR) and Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO, USA;2. Department of Internal Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;1. Center for Pancreatic Disease, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;2. Department of Internal Medicine, University of Southern California Keck School of Medicine, Los Angeles, California;3. Department of Laboratory Medicine, University of Southern California Keck School of Medicine, Los Angeles, California;4. Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, California;1. Department of Internal Medicine, Division of Gastroenterology, University of Southern California Keck School of Medicine, Los Angeles, California;2. Center for Center for Pancreatic Disease, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA;2. Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082, India |
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| Abstract: | ![]()
Background/Aims:We evaluated the impact of the initial intravenous fluid resuscitation rate within the first 24 h of presentation to the emergency room on important outcomes in severe acute pancreatitis. Methods: Patients presenting directly with a diagnosis of severe acute pancreatitis were identified retrospectively. Patients were divided into two groups — those who received ≥.33% (‘early resuscitation’) and <33% (‘late resuscitation’) of their cumulative 72-hour intravenous fluid volume within the first 24 h of presentation.The primary clinical outcomes were in-hospital mortality, development of persistent organ failure, and duration of hospitalization. Results: 17 patients were identified in the ‘early resuscitation’ group and 28 in the ‘late resuscitation’ group and there were no baseline differences in clinical characteristics between groups. Patients in the ‘late resuscitation’ group experienced greater mortality than those in the ‘early resuscitation’ group (18 vs. 0%,p<0.04) and demonstrated a trend toward greater rates of persistent organ failure (43 vs. 35%, p = 0.31). There was no difference in the total amount of fluid given during the first 72 h. Conclusions: Patients with severe acute pancreatitis who do not receive at least one third of their initial 72-hour cumulative intravenous fluid volume during the first 24 h are at riskfor greater mortality than those who are initially resuscitated more aggressively. |
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