Comparison of clinical outcomes between aggressive and non-aggressive intravenous hydration for acute pancreatitis: a systematic review and meta-analysis

Abstract

Background Current practice guidelines for optimal infusion rates during early intravenous hydration in patients with acute pancreatitis (AP) remain inconsistent. This systematic review and meta-analysis aimed to compare treatment outcomes between aggressive and non-aggressive intravenous hydration in severe and non-severe AP. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched PubMed, Embase and Cochrane Library for randomized controlled trials (RCTs) on November 23, 2022, and hand-searched the reference lists of included RCTs, relevant review articles and clinical guidelines. We included RCTs that compared clinical outcomes from aggressive and non-aggressive intravenous hydration in AP. Meta-analysis was performed using a random-effects model for participants with severe AP and non-severe AP. Our primary outcome was all-cause mortality, and several secondary outcomes included fluid-related complications, clinical improvement and APACHE II scores within 48 h. Results We included a total of 9 RCTs with 953 participants. The meta-analysis indicated that, compared to non-aggressive intravenous hydration, aggressive intravenous hydration significantly increased mortality risk in severe AP (pooled RR: 2.45, 95% CI: 1.37, 4.40), while the result in non-severe AP was inconclusive (pooled RR: 2.26, 95% CI: 0.54, 9.44). However, aggressive intravenous hydration significantly increased fluid-related complication risk in both severe (pooled RR: 2.22, 95% CI 1.36, 3.63) and non-severe AP (pooled RR: 3.25, 95% CI: 1.53, 6.93). The meta-analysis indicated worse APACHE II scores (pooled mean difference: 3.31, 95% CI: 1.79, 4.84) in severe AP, and no increased likelihood of clinical improvement (pooled RR:1.20, 95% CI: 0.63, 2.29) in non-severe AP. Sensitivity analyses including only RCTs with goal-directed fluid therapy after initial fluid resuscitation therapy yielded consistent results. Conclusions Aggressive intravenous hydration increased the mortality risk in severe AP, and fluid-related complication risk in both severe and non-severe AP. More conservative intravenous fluid resuscitation protocols for AP are suggested. Graphical Abstract

Biomimetic Trypsin-Responsive Structure-Bridged Mesoporous Organosilica Nanomedicine for Precise Treatment of Acute Pancreatitis

“…1−3 The findings of randomized clinical trials on AP pharmacotherapy have been limited, and there are still no specific and targeted therapies available for AP in clinical applications. 4,5 The primary cause of AP is intracellular calcium overload and premature and massive trypsin activation, resulting in autodigestion of pancreatic acinar cells (PACs) and then provokes oxidative stress injury, pancreatic and peripancreatic necrosis, systemic inflammatory response syndrome, and even multiple organ failure. 6−10 However, the currently available pancreas-protective drugs only target one aspect of the downstream pathophysiological pathways, making it challenging to reverse the two main drivers of pathology from the root.…”

“…Severe acute pancreatitis (AP), a severe acute inflammatory disease, is one of the most common gastrointestinal diseases encountered in the emergency department and is associated with a high mortality rate (40%). − The findings of randomized clinical trials on AP pharmacotherapy have been limited, and there are still no specific and targeted therapies available for AP in clinical applications. , …”