Response and outcome from fluid resuscitation in acute pancreatitis: a prospective cohort study

Jin, Tao; Jiang, Kun; Deng, Lihui; Guo, Jia; Wu, Yinghai; Wang, Zhengyan; Shi, Na; Zhang, Xiaoxin; Lin, Ziqi; Asrani, Varsha M.; Jones, P. G.; Mittal, Anubhav; Phillips, Anthony R.J.; Huang, Wei; Yang, Xiaonan; Xia, Qing; Windsor, John A.

doi:10.1016/j.hpb.2018.05.018

Cited by 15 publications

(11 citation statements)

References 42 publications

(46 reference statements)

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“…3). The finding is consistent with studies which showed that rapid and high volume fluid therapy increases the risk of pulmonary edema and exacerbates respiratory failure in AP [13,24]. Our study has several limitations.…”

Section: Discussionsupporting

confidence: 91%

“…The primary clinical outcome measure was the rate of NPPV. We have selected NPPV as the primary endpoint because respiratory dysfunction/failure is the most common organ system affected, and because we have demonstrated that the most frequently noted consequence of ERFT is respiratory dysfunction [24]. In our setting, NPPV is the most commonly used means of organ support and it is frequently used in the general ward setting, and has been shown to reduce the need for ICU admission and invasive ventilation [34].…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly used goals of fluid resuscitation are the normalization of urine output and blood pressure [23], but this has been shown to risk fluid overload and increased mortality [24]. The laboratory marker that shows promise as a goal and a guide to fluid therapy in patients with AP is hematocrit [25].…”

Section: Introductionmentioning

confidence: 99%

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Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Jin

Wen

et al. 2020

Dig Dis Sci

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Background/Aims Hematocrit is a widely used biomarker to guide early fluid therapy for patients with acute pancreatitis (AP), but there is controversy over whether early rapid fluid therapy (ERFT) should be used in hemoconcentrated patients. This study investigated the association of hematocrit and ERFT with clinical outcomes of patients with AP. Methods Data from prospectively maintained AP database and retrospectively collected fluid management details were stratified according to actual severity defined by revised Atlanta classification. Hemoconcentration and "early" were defined as hematocrit > 44% and the first 6 h of general ward admission, respectively, and "rapid" fluid rate was defined as ≥ 3 ml/ kg/h. Patients were allocated into 4 groups for comparisons: group A, hematocrit ≤ 44% and fluid rate < 3 ml/kg/h; group B, hematocrit ≤ 44% and fluid rate ≥ 3 ml/kg/h; group C, hematocrit > 44% and fluid rate < 3 ml/kg/h; and group D, hematocrit > 44% and fluid rate ≥ 3 ml/kg/h. Primary outcome was rate of noninvasive positive-pressure ventilation (NPPV). Results A total of 912 consecutive AP patients were analyzed. ERFT has no impact on clinical outcomes of hemoconcentrated, non-severe or all non-hemoconcentrated AP patients. In hemoconcentrated patients with severe AP (SAP), ERFT was accompanied with increased risk of NPPV (odds ratio 5.96, 95% CI 1.57-22.6). Multivariate regression analyses confirmed ERFT and hemoconcentration were significantly and independently associated with persistent organ failure and mortality in patients with SAP. Conclusions ERFT is associated with increased rate of NPPV in hemoconcentrated patients with SAP.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Jin

Wen

et al. 2020

Dig Dis Sci

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“…We maintain that shortening the duration of all organ failure is an important treatment target and should be routinely reported. This is illustrated by recent findings that early initiation of aggressive fluid therapy may be helpful, but if delayed 6–8 hours after admission the risk of POF and mortality may be increased 9. The frequent early onset of POF and impact of its duration underline the importance of door-to-needle time10 and the duration of POF as an outcome in clinical trials of new treatments for AP.…”

mentioning

confidence: 99%

Duration of organ failure impacts mortality in acute pancreatitis

Shi

Liu

Iglesia‐García

et al. 2019

Gut

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“…Klinische Auswertungen zu Patienten auf Überwachungsstationen belegen, dass Informationen über Oligurie, Anurie bzw. eingeschränkte Diuresemengen als unabhängige, hochsensitive und frühzeitige Marker für die Diagnose eines AKI verwendet werden können[88][89][90]. Limitierend ist, dass eine genaue Bilanzierung und Bestimmung der stündlichen Diuresemenge nur mittels Blasenkatheters und bei entsprechendem Personalschlüssel gewähr-Biomarker zur Diagnostik des AP-AKI.…”

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Pankreatitisbedingte akute Nierenschädigung (AP-AKI): Definition, Pathophysiologie, Diagnostik und Therapie

et al. 2020

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ZusammenfassungDie akute Pankreatitis (AP) stellt die häufigste gastrointestinale Ursache für Krankenhausaufnahmen dar. Die Mortalität liegt bei 5 %, kann jedoch in Abhängigkeit vom Schweregrad auf bis zu 40 % ansteigen. Insbesondere schwere Verlaufsformen sind mit einem Multiorganversagen vergesellschaftet und haben eine schlechte Prognose. In diesem Zusammenhang kann es bei bis zu 10 % der Patienten zum akuten Nierenversagen (Acute kidney injury, AKI) kommen, das sich meistens spät nach dem Versagen anderer Organe entwickelt, aber auch initial oder isoliert auftreten kann. Darüber hinaus bestimmt das AKI als Komplikation der schweren Pankreatitis maßgeblich die Prognose, da die Mortalität, vor allem bei dialysepflichtigem AKI, auf bis zu 75 % dramatisch ansteigen kann.Im Vergleich zu anderen intensivmedizinisch assoziierten AKIs (z. B. Volumenmangel, kardiales Pumpversagen, Sepsis oder Intoxikationen) weist das mit einer AP assoziierte AKI (AP-AKI) viele Gemeinsamkeiten, aber auch deutliche Unterschiede auf. Die zwei existierenden Formen des AP-AKI (initiale prärenale Schädigung aufgrund eines Volumenmangels, intrarenale Schädigung in der Spätphase) können aufeinander folgend, aber auch unabhängig voneinander auftreten. Obwohl die Pathophysiologie gänzlich unverstanden ist, scheint eine systemische und lokale entzündliche Reaktion eine wichtige Rolle zu spielen. Die frühe Diagnose und die rechtzeitige Einleitung einer effektiven supportiven und ätiopathogenetisch gerichteten Therapie kann die Prognose deutlich verbessern. Ungeachtet dessen finden sich derzeit nur wenige Studien, die sich explizit mit AKI und Pankreatitis befassen.In der vorliegenden Übersicht konzentrieren wir uns – unter Verwendung der aktuellsten Literatur – auf die zugrunde liegenden pathophysiologischen Mechanismen des AP-AKI, untersuchen in dieser Hinsicht den diagnostischen und prognostischen Stellenwert alter und neuer Serum- und Urinmarker und diskutieren die für die AP-AKI empfohlenen Behandlungsansätze inklusive möglicher Nierenersatzverfahren.

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Response and outcome from fluid resuscitation in acute pancreatitis: a prospective cohort study

Cited by 15 publications

References 42 publications

Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Duration of organ failure impacts mortality in acute pancreatitis

Pankreatitisbedingte akute Nierenschädigung (AP-AKI): Definition, Pathophysiologie, Diagnostik und Therapie

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