Aggressive Resuscitation Is Associated with the Development of Acute Kidney Injury in Acute Pancreatitis

Ye, Bo; Mao, Wenjian; Chen, Yuhui; Tong, Zhihui; Chen, Yingjie; Zhou, Jing; Ke, Lu; Li, Weiqin

doi:10.1007/s10620-018-5328-5

Cited by 27 publications

(45 citation statements)

References 37 publications

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“…Regarding hyperfluid reposition in AP patients, contradictory findings have been published on the incidence of organ failure and abdominal compartment syndrome when hyperfluid resuscitation policy was installed [34,35]. Recent data showed that hyperfluid hydration in AP increases the risk of acute kidney injury, pulmonary oedema, compartmental syndrome, sepsis, and mortality [36][37][38][39][40][41][42]. In this line, some studies recently explored the impact of fluid sequestration in AP, showing that its presence is related to poor outcomes, including severe AP persistent organ failure, ICU admission, or more hospital stay [43,44].…”

Section: Discussionmentioning

confidence: 99%

Early Changes in Blood Urea Nitrogen (BUN) Can Predict Mortality in Acute Pancreatitis: Comparative Study between BISAP Score, APACHE-II, and Other Laboratory Markers—A Prospective Observational Study

Pando

Alberti

Mata

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Background. Changes in BUN have been proposed as a risk factor for complications in acute pancreatitis (AP). Our study aimed to compare changes in BUN versus the Bedside Index for Severity in Acute Pancreatitis (BISAP) score and the Acute Physiology and Chronic Health Evaluation-II score (APACHE-II), as well as other laboratory tests such as haematocrit and its variations over 24 h and C-reactive protein, in order to determine the most accurate test for predicting mortality and severity outcomes in AP. Methods. Clinical data of 410 AP patients, prospectively enrolled for study at our institution, were analyzed. We define AP according to Atlanta classification (AC) 2012. The laboratory test’s predictive accuracy was measured using area-under-the-curve receiver-operating characteristics (AUC) analysis and sensitivity and specificity tests. Results. Rise in BUN was the only score related to mortality on the multivariate analysis ( p = 0.000 , OR: 12.7; CI 95%: 4.2−16.6). On the comparative analysis of AUC, the rise in BUN was an accurate test in predicting mortality (AUC: 0.842) and persisting multiorgan failure (AUC: 0.828), similar to the BISAP score (AUC: 0.836 and 0.850) and APACHE-II (AUC: 0.756 and 0.741). The BISAP score outperformed both APACHE-II and rise in BUN at 24 hours in predicting severe AP (AUC: 0.873 vs. 0.761 and 0.756, respectively). Conclusion. Rise in BUN at 24 hours is a quick and reliable test in predicting mortality and persisting multiorgan failure in AP patients.

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Section: Discussionmentioning

confidence: 99%

Early Changes in Blood Urea Nitrogen (BUN) Can Predict Mortality in Acute Pancreatitis: Comparative Study between BISAP Score, APACHE-II, and Other Laboratory Markers—A Prospective Observational Study

Pando

Alberti

Mata

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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“…Aggressive volume resuscitation ($7.5 L within 6 hours from hospital admission) was also found to be an independent predictor of developing abdominal compartment syndrome (31). Another study of 179 patients with moderately severe acute pancreatitis showed that aggressive fluid resuscitation ($4 L) was associated with increased incidence of AKI compared the nonaggressive group (53.12% versus 25.64%; P50.008), and longer AKI lasting time (P50.04) (32).…”

Section: Fluid Managementmentioning

confidence: 96%

AKI Associated with Acute Pancreatitis

Nassar

Qunibi

2019

CJASN

102

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Acute pancreatitis is a common disorder of the pancreas. It is the most frequent gastrointestinal cause for hospitalization and one of the leading causes of in-hospital deaths. Its severity ranges from mild self-limited disease to severe acute necrotizing pancreatitis characterized by systemic complications and multiorgan failure. Severe acute pancreatitis develops in about 20% of patients with acute pancreatitis and may be associated with multiorgan failure (respiratory, cardiovascular, and kidney). AKI is a frequent complication of severe acute pancreatitis and develops late in the course of the disease, usually after the failure of other organs. It carries a very poor prognosis, particularly if kidney replacement therapy is required, with mortality rates exceeding 75%. The exact pathophysiology of AKI in acute pancreatitis remains unclear but appears to result from initial volume depletion followed by complex vascular and humoral factors. Here, we provide an overview of the epidemiology, pathogenesis, causes, and management of AKI in patients with severe acute pancreatitis.

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“…Thirteen studies [12][13][14][15][16][17][18][19][20][28][29][30][31] published from 2009 to 2020 that included 3,127 patients ful lled the selection criteria and were included in the nal meta-analysis (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Aggressive Versus Conservative Fluid Treatment for Acute Pancreatitis in Adult Patients: A Meta-Analysis of 3,127 Cases

Liao¹,

Zhan

Wu³

et al. 2021

Preprint

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Background: The advantages of aggressive fluid treatment (AFT) compared to conservative fluid treatment (CFT) within 24 h for acute pancreatitis (AP) remain controversial in adult patients. A meta-analysis was undertaken to investigate whether aggressive strategies are more beneficial.Methods: We searched (on February 1, 2021) PubMed, Embase, and the Cochrane Library for eligible trials that assessed the two therapies and performed a meta-analysis. The primary endpoint was in-hospital mortality. Secondary outcomes were adverse events (e.g., renal failure and pancreatic necrosis) within 24 h of treatment.Results: Five randomized controlled trials (RCTs) and 8 observational studies involving 3,127 patients were identified. There was a significant difference in in-hospital mortality for AFT compared to CFT (OR, 1.66; P = 0.0001). The incidences of renal failure (OR, 2.38; P < 0.00001) and pancreatic necrosis (OR, 2.34; P < 0.0001) were similar and significantly different between the two groups. Patients aged > 50 years had a potentially higher utilization of mechanical ventilation and incidence of respiratory failure (OR, 4.88; P < 0.00001). Persistent organ failure, systemic inflammatory response syndrome (SIRS) and length of hospital stay did not differ significantly between the two groups. Sensitivity analysis identified two significant changes: one in persistent SIRS (OR, 2.37; P = 0.02) in patients aged > 50 years and one in the overall incidence of persistent organ failure (OR, 1.81; P = 0.02).Conclusions: Compared to CFT, AFT increases in-hospital mortality and the incidence of renal failure, pancreatic necrosis and respiratory failure with relatively strong evidence.

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Aggressive Resuscitation Is Associated with the Development of Acute Kidney Injury in Acute Pancreatitis

Cited by 27 publications

References 37 publications

Early Changes in Blood Urea Nitrogen (BUN) Can Predict Mortality in Acute Pancreatitis: Comparative Study between BISAP Score, APACHE-II, and Other Laboratory Markers—A Prospective Observational Study

Early Changes in Blood Urea Nitrogen (BUN) Can Predict Mortality in Acute Pancreatitis: Comparative Study between BISAP Score, APACHE-II, and Other Laboratory Markers—A Prospective Observational Study

AKI Associated with Acute Pancreatitis

Aggressive Versus Conservative Fluid Treatment for Acute Pancreatitis in Adult Patients: A Meta-Analysis of 3,127 Cases

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