The Effect of Early Aggressive Fluid Resuscitation on Morbidity and Mortality in Acute Pancreatitis

Abstract

BACKGROUND & AIM: Early aggressive fluid resuscitation is a beneficial treatment for acute pancreatitis. However, the degree of this benefit is not known. We aimed to determine the effect of early aggressive fluid resuscitation on important outcomes such as SIRS, organ failure, and mortality in patients admitted with acute pancreatitis. METHODS: All nontransferred patients admitted to our medical center from 1985-2009 with a primary diagnosis of acute pancreatitis were identified and data extraction performed retrospectively. Early aggressive resuscitation was defined as receiving ≥ 1/3 of the total 72 hour fluid volume within the first 24 hours of presentation. Late resuscitation was defined as receiving ≤ 1/ 3 of the total 72 hour fluid volume within the first 24 hours of presentation. The primary study outcomes were the effect of fluid resuscitation on SIRS, organ failure, and mortality. Data were analyzed via standard chi-square analysis and student's t-tests, respectively and multivariate regression performed for confounders of age, comorbidity and gender. RESULTS: 434 patients were included in the analysis; 340 were categorized in the early resuscitation group and 94 in the late resuscitation group. Patients in the early resuscitation group received more IV fluids in the first 24 hours (3,493 ml vs. 2,402 ml, p < 0.001) but less total fluids in the first 72 hours (7,600 ml vs. 9,514 ml, p = 0.001) compared with the late resuscitation group. Early fluid resuscitation led to decreased SIRS at 24 (15% vs. 32%, p = 0.001), 48 (14% vs. 33%, p = 0.001), and 72 (10% vs. 23%, p = 0.01) hours respectively (p < 0.01) as well as decreased organ failure at 72 hours (5% vs. 10%, p < 0.05), a lower rate of ICU admission (6% vs. 17%, p < 0.001) and a shortened length of stay (8 vs. 11 days, p = 0.01) . Although not statistically significant, organ failure at 24 and 48 hours was also improved in the early resuscitation group. There was no significant difference in mortality between the two groups. Subgroup analysis demonstrated these benefits to be more pronounced in patients with interstitial rather than severe pancreatitis at admission. CONCLUSIONS: In patients with acute pancreatitis, early aggressive fluid resuscitation within the first twentyfour hours reduces the development of systemic inflammatory response syndrome (SIRS), organ failure, the need for ICU admission, and overall hospital length of stay in patients presenting with interstitial disease. In patients presenting with severe acute pancreatitis the benefit of early aggressive fluid resuscitation was not seen.