Influence of Fluid Therapy on the Prognosis of Acute Pancreatitis: A Prospective Cohort Study.
Summary of "Influence of Fluid Therapy on the Prognosis of Acute Pancreatitis: A Prospective Cohort Study."
OBJECTIVES:
Although aggressive fluid therapy during the first days of hospitalization is recommended by most guidelines and reviews on acute pancreatitis (AP), this recommendation is not supported by any direct evidence. We aimed to evaluate the association between the amount of fluid administered during the initial 24 h of hospitalization and the incidence of organ failure (OF), local complications, and mortality.
METHODS:
This was a prospective cohort study. We included consecutive adult patients admitted with AP. Local complications and OF were defined according to the Atlanta Classification. Persistent OF was defined as OF of >48-h duration. Patients were divided into three groups according to the amount of fluid administered during the initial 24 h: group
A:
<3.1 l (less than the first quartile), group
B:
3.1-4.1 l (between the first and third quartiles), and group
C:
>4.1 l (more than the third quartile).
RESULTS:
A total of 247 patients were analyzed. Administration of >4.1 l during the initial 24 h was significantly and independently associated with persistent OF, acute collections, respiratory insufficiency, and renal insufficiency. Administration of <3.1 l during the initial 24 h was not associated with OF, local complications, or mortality. Patients who received between 3.1 and 4.1 l during the initial 24 h had an excellent outcome.
CONCLUSIONS:
In our study, administration of a small amount of fluid during the initial 24 h was not associated with a poor outcome. The need for a great amount of fluid during the initial 24 h was associated with a poor outcome; therefore, this group of patients must be carefully monitored.Am J Gastroenterol advance online publication, 30 August 2011; doi:10.1038/ajg.2011.236.
Affiliation
Pancreatic Unit, Hospital General Universitario de Alicante, Alicante, Spain.
Journal Details
This article was published in the following journal.
Name: The American journal of gastroenterology
ISSN: 1572-0241
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21876561
- DOI: http://dx.doi.org/10.1038/ajg.2011.236
Medical and Biotech [MESH] Definitions
Pancreatitis
INFLAMMATION of the PANCREAS. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of CHRONIC PANCREATITIS (International Symposium on Acute Pancreatitis, Atlanta, 1992). The two most common forms of acute pancreatitis are ALCOHOLIC PANCREATITIS and gallstone pancreatitis.
Pancreatitis, Alcoholic
Acute or chronic INFLAMMATION of the PANCREAS due to excessive ALCOHOL DRINKING. Alcoholic pancreatitis usually presents as an acute episode but it is a chronic progressive disease in alcoholics.
Cohort Effect
Variation in health status arising from different causal factors to which each birth cohort in a population is exposed as environment and society change.
Karnofsky Performance Status
A performance measure for rating the ability of a person to perform usual activities, evaluating a patient's progress after a therapeutic procedure, and determining a patient's suitability for therapy. It is used most commonly in the prognosis of cancer therapy, usually after chemotherapy and customarily administered before and after therapy. It was named for Dr. David A. Karnofsky, an American specialist in cancer chemotherapy.
Pancreatitis, Acute Necrotizing
A severe form of acute INFLAMMATION of the PANCREAS characterized by one or more areas of NECROSIS in the pancreas with varying degree of involvement of the surrounding tissues or organ systems. Massive pancreatic necrosis may lead to DIABETES MELLITUS, and malabsorption.
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