Research Article

Aggressive hydration in early resuscitation phase does not provide mortality benefit in acute pancreatitis

Abu Omar Y*, Attar BM, Wang Y, Agrawal R, Randhawa T, Majeed M, Simons-Linares CR and Demetria MV

Published: 05 December, 2019 | Volume 3 - Issue 1 | Pages: 035-040

Introduction: Fluid management is the cornerstone of treatment for acute pancreatitis (AP), but the proper rate and volume is still controversial. We aim to evaluate the role of aggressive hydration in AP patients.

Methods: We retrospectively reviewed and analyzed 279 hospitalized patients of AP. Severity was determined by the Revised Atlanta classification; validated clinical scores were also calculated based on clinical information upon presentation. We extracted amount of fluid received by at 6, 12, 24 and 48 hours after presentation. Aggressive hydration was defined as amount higher than 10 ml/kg bolus followed by infusion at 1.5 ml/kg/h. After direct comparison between aggressive versus non-aggressive hydration groups, propensity-score match was performed to control severity, APACHE II and BISAP score. Post-match comparison as well as a subgroup comparison were conducted.

Results: At 24 hours, 125 (44.8%) patients received aggressive hydration averaged at 5.1 L (2-18 L), while 154 (55.2%) patients received non-aggressive hydration averaged at 2.5 L. Post-match comparison showed that aggressive hydration group had longer hospital stay (MAP: 5.3 vs 4.5, p = 0.145, MSAP/SAP: 8.3 vs 4.8 d, p = 0.007), and higher rate of intensive care unit admission (mild: 12.9% vs 4.4%, p = 0.042, moderately severe or severe: 36.8% vs 3.1%, p = 0.001), while showed no difference in rate of mortality or re-admission by 1 year. In patients who presented without organ failure, aggressive hydration did not change the rate of development of organ failure (14.1% vs 12.5%, p = 0.731), but the aggressive hydration group had a trend towards longer hospital stay (5.5 vs 4.6 d, p = 0.083) and higher rate of MICU admission (12.1% vs 4.8%, p = 0.051)

Read Full Article HTML DOI: 10.29328/journal.acgh.1001013 Cite this Article Read Full Article PDF


Acute pancreatitis; Aggressive hydration


  1. Peery AF, Dellon ES, Lund J. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012; 143: 1179-1187. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22885331
  2. Toouli J, Brooke-Smith M, Bassi C. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol. 2002; 17: 15-39. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12000591
  3. Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, et al. Early crystalloid fluid volume management in acute pancreatitis: association with mortality and organ failure. Pancreatology. 2011; 11: 351-361. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21757973
  4. Mao E, Tang Y, Li L. Strategy of controlling fluid resuscitation for severe acute pancreatitis in acute phase. Zhonghua Wai Ke Za Zhi. 2007; 45: 1331-1334. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18241568
  5. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995; 23: 1638-1652. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7587228
  6. Banks PA, Bollen TL, Dervenis C. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62: 102-111. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23100216
  7. Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis. Arch Surg. 1993; 128: 586-590. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8489394
  8. Buxbaum JL, Quezada M, Da B. Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. Am J Gastroenterol. 2017; 112: 797-803. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28266591
  9. Wu BU, Hwang JQ, Gardner TH. Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011; 9: 710-717.PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21645639
  10. Murakami T, Fujita T. Microcirculation of the rat pancreas, with special reference to the insulo-acinar portal and insulo-venous drainage systems: a further scanning electron microscope study of corrosion casts. Arch Histol Cytol. 1992; 55: 453-476. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1295546
  11. Pandol SJ, Saluja AK, Imrie CW, Banks PA. Acute pancreatitis: bench to the bedside. Gastroenterology. 2007; 132: 1127-1151. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17383433
  12. Bockman DE. Microvasculature of the pancreas. Relation to pancreatitis. Int J Pancreatol. 1992; 12: 11-21. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1527446
  13. Nguyen HB, Jaehne AK, Jayaprakash N. Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE. Crit Care. 2016; 20: 160. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27364620
  14. Haydock MD, Mittal A, Wilms HR, Phillips A, Petrov MS, et al. Fluid therapy in acute pancreatitis: anybody’s guess. Ann Surg. 2013; 257: 182-188. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23207241
  15. Mao EQ, Fei J, Peng YB, Huang J, Tang YQ, et al. Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. Chin Med J (Engl). 2010; 123: 1639-1644. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20819621
  16. De Waele JJ, Leppaniemi AK. Intra-abdominal hypertension in acute pancreatitis. World J Surg. 2009; 33: 1128-1133. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19350318
  17. De-Madaria E, Soler-Sala G, Sanchez-Paya J. Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol. 2011; 106: 1843-1850. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21876561
  18. Mao E, Tang Y, Fei J. Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl). 2009; 122: 169-173. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19187641
  19. Wang M-D, Ji Y, Xu J, Jiang D-H, Luo L, et al. Early goal-directed fluid therapy with fresh frozen plasma reduces severe acute pancreatitis mortality in the intensive care unit. Chin Med J (Engl). 2013; 126: 1987-1988. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23673124
  20. Eckerwall G, Olin H, Andersson B, Andersson R. Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: what have we learned and how can we do better? Clin Nutr. 2006; 25: 497-504. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16337067
  21. Brown A, Baillargeon JD, Hughes MD, Banks PA. Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis? Pancreatology. 2002; 2: 104-107. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12123089
  22. ardner TB, Vege SS, Chari ST. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality. Pancreatology. 2009; 9: 770-776. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20110744
  23. Wall I, Badalov N, Baradarian R, Iswara K, Li JJ, et al. Decreased mortality in acute pancreatitis related to early aggressive hydration. Pancreas. 2011; 40: 547-550. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21499208
  24. Warndorf MG, Kurtzman JT, Bartel MJ. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011; 9: 705-709. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21554987

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More