Efficacy and safety of aggressive fluid resuscitation versus conventional fluid resuscitation in early treatment of acute pancreatitis： A Meta－analysis

Zhangpeng WANG; Guangxu JING; Huanhuan LUO; Hongfei DONG; Xuyang WANG; Hongyu SUN; Lijun TANG

doi:10.3969/j.issn.1001-5256.2023.09.019

Volume 39 Issue 9

Sep. 2023

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Article Navigation > Journal of Clinical Hepatology > 2023 > 39(9): 2158-2168

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Efficacy and safety of aggressive fluid resuscitation versus conventional fluid resuscitation in early treatment of acute pancreatitis： A Meta－analysis

DOI: 10.3969/j.issn.1001-5256.2023.09.019

Zhangpeng WANG^{1a, 2},
Guangxu JING^{1a, 2},
Huanhuan LUO^{1a, 3},
Hongfei DONG^1a,
Xuyang WANG^{1a, 4},
Hongyu SUN^{1a, 1b},
Lijun TANG^{1a, 2
,
,
,}

1a.
PLA Center of General Surgery/Key Laboratory of Pancreatic Injury and Repair of Sichuan Province，The General Hospital of Western Theater Command，Chengdu 610083，China
1b.
Basic Medical Laboratory，The General Hospital of Western Theater Command，Chengdu 610083，China
2.
College of Medicine，Southwest Medical University，Luzhou，Sichuan 646000，China
3.
College of Medicine，Southwest Jiaotong University，Chengdu 610063，China
4.
College of Medicine，Chongqing Medical University，Chongqing 400016，China

Research funding:

National Natural Science Foundation of China (81772001);

National Clinical Key Subject of China (41732113);

Science and Technology Foundation of Sichuan Province (2019YJ0277)

More Information

Corresponding author: TANG Lijun， tanglj2016@163.com （ORCID： 0000－0001－6000－9515）
Received Date: 2022-12-04
Accepted Date: 2022-12-31
Published Date: 2023-09-19

Abstract

Abstract

Objective To systematically evaluate the efficacy and safety of aggressive fluid resuscitation versus conventional fluid resuscitation in the early treatment of acute pancreatitis （AP）， and to provide a reference for clinical research and practice. Methods This study was conducted according to PRISMA guidelines， with a PROSPERO registration number of CRD42023455046. Chinese and English databases such as PubMed， the Cochrane Library， Web of Science， CNKI， VIP， and Wanfang Data were searched for randomized controlled trials and cohort studies on the clinical efficacy of aggressive fluid resuscitation versus conventional fluid resuscitation in the treatment of AP published up to November 30， 2022. RevMan 5.4 and Stata 17.0 were used to perform the meta－analysis. Results A total of 15 studies were included， with 4 061 patients in total. The meta－analysis showed that compared with the conventional fluid resuscitation group， the aggressive fluid resuscitation group had significantly higher incidence rate of persistent organ failure （odds ratio ［OR］=2.19， 95% confidence interval ［CI］： 1.46－3.29， P<0.001）， incidence rate of pancreatic necrosis （OR=1.73， 95%CI： 1.19－2.51， P=0.004）， and mortality rate （OR=1.64， 95%CI： 1.26－2.14， P<0.001）， as well as significantly higher risks of infectious pancreatic necrosis （OR=1.82， 95%CI： 1.33－2.48， P<0.001）， circulatory failure （OR=6.31， 95%CI： 1.81－21.93， P=0.004）， respiratory failure （OR=3.81， 95%CI： 1.77－8.19， P<0.001）， renal failure （OR=1.88， 95%CI： 1.11－3.19， P=0.02）， abdominal compartment syndrome （OR=6.01， 95%CI： 2.45－14.71， P<0.001）， and fluid overload （OR=3.83， 95%CI： 1.65－8.88， P=0.002）. Conclusion Aggressive fluid resuscitation shows poor efficacy and safety in the early treatment of AP and may be unfavorable to the prognosis of patients. Due to the limited quantity and quality of studies included， more large multicenter randomized controlled trials are needed for verification in the future.
- Pancreatitis,
- Fluid Resuscitation,
- Treatment Outcome,
- Meta－Analysis

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References(44)

References

[1]	BOXHOORN L, VOERMANS RP, BOUWENSE SA, et al. Acute pancreatitis[J]. Lancet, 2020, 396( 10252): 726－ 734. DOI: 10.1016/S0140－6736(20)31310－6.
[2]	Chinese Society for Emergency Medicine; Beijing－Tianjin－Hebei Alliance of Emergency Treatment and First Aid; Emergency Medicine Branch, Beijing Medical Association, et al. Expert consensus on emergency diagnosis and treatment of acute pancreatitis[J]. J Clin Hepatol, 2021, 37( 5): 1034－ 1041. DOI: 10.3969/j.issn.1001－5256.2021.05.012. 中华医学会急诊分会, 京津冀急诊急救联盟, 北京医学会急诊分会, 等. 急性胰腺炎急诊诊断及治疗专家共识[J]. 临床肝胆病杂志, 2021, 37( 5): 1034－ 1041. DOI: 10.3969/j.issn.1001－5256.2021.05.012.
[3]	MEDEROS MA, REBER HA, GIRGIS MD. Acute pancreatitis: A review[J]. JAMA, 2021, 325( 4): 382－ 390. DOI: 10.1001/jama.2020.20317.
[4]	SZATMARY P, GRAMMATIKOPOULOS T, CAI W, et al. Acute pancreatitis: Diagnosis and treatment[J]. Drugs, 2022, 82( 12): 1251－ 1276. DOI: 10.1007/s40265－022－01766－4.
[5]	SARR MG. Early fluid“resuscitation/therapy” in acute pancreatitis: which fluid? What rate? What parameters to gauge effectiveness?[J]. Ann Surg, 2013, 257( 2): 189－ 190. DOI: 10.1097/SLA.0b013e318280e19e.
[6]	SINGH VK, GARDNER TB, PAPACHRISTOU GI, et al. An international multicenter study of early intravenous fluid administration and outcome in acute pancreatitis[J]. United European Gastroenterol J, 2017, 5( 4): 491－ 498. DOI: 10.1177/2050640616671077.
[7]	GARDNER TB, VEGE SS, PEARSON RK, et al. Fluid resuscitation in acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2008, 6( 10): 1070－ 1076. DOI: 10.1016/j.cgh.2008.05.005.
[8]	WEITZ G, WOITALLA J, WELLHÖNER P, et al. Detrimental effect of high volume fluid administration in acute pancreatitis－a retrospective analysis of 391 patients[J]. Pancreatology, 2014, 14( 6): 478－ 483. DOI: 10.1016/j.pan.2014.07.016.
[9]	DE－MADARIA E, SOLER－SALA G, SÁNCHEZ－PAYÁ J, et al. Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study[J]. Am J Gastroenterol, 2011, 106( 10): 1843－ 1850. DOI: 10.1038/ajg.2011.236.
[10]	DE－MADARIA E, BUXBAUM JL, MAISONNEUVE P, et al. Aggressive or moderate fluid resuscitation in acute pancreatitis[J]. N Engl J Med, 2022, 387( 11): 989－ 1000. DOI: 10.1056/NEJMoa2202884.
[11]	MAO EQ, TANG YQ, FEI J, et al. Fluid therapy for severe acute pancreatitis in acute response stage[J]. Chin Med J(Engl), 2009, 122( 2): 169－ 173.
[12]	BANKS PA, BOLLEN TL, DERVENIS C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62( 1): 102－ 111. DOI: 10.1136/gutjnl－2012－302779.
[13]	YE B, MAO W, CHEN Y, et al. Aggressive resuscitation is associated with the development of acute kidney injury in acute pancreatitis[J]. Dig Dis Sci, 2019, 64( 2): 544－ 552. DOI: 10.1007/s10620－018－5328－5.
[14]	STANG A. Critical evaluation of the Newcastle－Ottawa scale for the assessment of the quality of nonrandomized studies in meta－analyses[J]. Eur J Epidemiol, 2010, 25( 9): 603－ 605. DOI: 10.1007/s10654－010－9491－z.
[15]	JADAD AR, MOORE RA, CARROLL D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17( 1): 1－ 12. DOI: 10.1016/0197－2456(95)00134－4.
[16]	MCGRATH S, ZHAO X, STEELE R, et al. Estimating the sample mean and standard deviation from commonly reported quantiles in meta－analysis[J]. Stat Methods Med Res, 2020, 29( 9): 2520－ 2537. DOI: 10.1177/0962280219889080.
[17]	BARILI F, PAROLARI A, KAPPETEIN PA, et al. Statistical Primer: heterogeneity, random－ or fixed－effects model analyses?[J]. Interact Cardiovasc Thorac Surg, 2018, 27( 3): 317－ 321. DOI: 10.1093/icvts/ivy163.
[18]	MESSALLAM AA, BODY CB, BERGER S, et al. Impact of early aggressive fluid resuscitation in acute pancreatitis[J]. Pancreatology, 2021, 21( 1): 69－ 73. DOI: 10.1016/j.pan.2020.11.006.
[19]	LIU J, WU PY, LIU L, et al. Impact of early active fluid resuscitation on patients initially assessed as non－severe acute pancreatitis[J]. Chin Gen Pract, 2021, 24( 27): 3457－ 3463. DOI: 10.12114/j.issn.1007－9572.2021.00.454. 刘俊, 武鹏宇, 刘莉, 等. 早期积极液体复苏对初始评估未达到重型标准的急性胰腺炎患者的影响研究[J]. 中国全科医学, 2021, 24( 27): 3457－ 3463. DOI: 10.12114/j.issn.1007－9572.2021.00.454.
[20]	ANGSUBHAKORN A, TIPCHAICHATTA K, CHIRAPONGSATHORN S. Comparison of aggressive versus standard intravenous hydration for clinical improvement among patients with mild acute pancreatitis: A randomized controlled trial[J]. Pancreatology, 2021, 21( 7): 1224－ 1230. DOI: 10.1016/j.pan.2021.06.004.
[21]	CUÉLLAR－MONTERRUBIO JE, MONREAL－ROBLES R, GONZÁLEZ－MORENO EI, et al. Nonaggressive versus aggressive intravenous fluid therapy in acute pancreatitis with more than 24 hours from disease onset: A randomized controlled trial[J]. Pancreas, 2020, 49( 4): 579－ 583. DOI: 10.1097/MPA.0000000000001528.
[22]	LI L, JIN T, WEN S, et al. Early rapid fluid therapy is associated with increased rate of noninvasive positive－pressure ventilation in hemoconcentrated patients with severe acute pancreatitis[J]. Dig Dis Sci, 2020, 65( 9): 2700－ 2711. DOI: 10.1007/s10620－019－05985－w.
[23]	LI H, GAO M, GE WW, et al. Application value of early active fluid resuscitation in mild acute pancreatitis[J]. Chin J Emerg Med, 2019, 28( 6): 794－ 797. DOI: 10.3760/cma.j.issn.1671－0282.2019.06.030. 李贺, 高明, 葛魏巍, 等. 早期积极液体复苏在轻症急性胰腺炎中的应用价值[J]. 中华急诊医学杂志, 2019, 28( 6): 794－ 797. DOI: 10.3760/cma.j.issn.1671－0282.2019.06.030.
[24]	YAMASHITA T, HORIBE M, SANUI M, et al. Large volume fluid resuscitation for severe acute pancreatitis is associated with reduced mortality: A multicenter retrospective study[J]. J Clin Gastroenterol, 2019, 53( 5): 385－ 391. DOI: 10.1097/MCG.0000000000001046.
[25]	BUXBAUM JL, QUEZADA M, DA B, et al. Early aggressive hydration hastens clinical improvement in mild acute pancreatitis[J]. Am J Gastroenterol, 2017, 112( 5): 797－ 803. DOI: 10.1038/ajg.2017.40.
[26]	WARNDORF MG, KURTZMAN JT, BARTEL MJ, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2011, 9( 8): 705－ 709. DOI: 10.1016/j.cgh.2011.03.032.
[27]	GARDNER TB, VEGE SS, CHARI ST, et al. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in－hospital mortality[J]. Pancreatology, 2009, 9( 6): 770－ 776. DOI: 10.1159/000210022.
[28]	DERVENIS C, JOHNSON CD, BASSI C, et al. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference[J]. Int J Pancreatol, 1999, 25( 3): 195－ 210. DOI: 10.1007/BF02925968.
[29]	BANKS PA, FREEMAN ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis[J]. Am J Gastroenterol, 2006, 101( 10): 2379－ 2400. DOI: 10.1111/j.1572－0241.2006.00856.x.
[30]	WHITCOMB DC. Clinical practice. Acute pancreatitis[J]. N Engl J Med, 2006, 354( 20): 2142－ 2150. DOI: 10.1056/NEJMcp054958.
[31]	PANDOL SJ, SALUJA AK, IMRIE CW, et al. Acute pancreatitis: bench to the bedside[J]. Gastroenterology, 2007, 132( 3): 1127－ 1151. DOI: 10.1053/j.gastro.2007.01.055.
[32]	TENNER S, BAILLIE J, DEWITT J, et al. American College of Gastroenterology guideline: management of acute pancreatitis[J]. Am J Gastroenterol, 2013, 108( 9): 1400－ 1415. DOI: 10.1038/ajg.2013.218.
[33]	KETWAROO G, SEALOCK RJ, FREEDMAN S, et al. Quality of care indicators in patients with acute pancreatitis[J]. Dig Dis Sci, 2019, 64( 9): 2514－ 2526. DOI: 10.1007/s10620－019－05674－8.
[34]	MAO EQ, LI MJ. Early fluid resuscitation and protection of organ function in severe acute pancreatitis[J]. Chin J Dig, 2020, 40( 7): 441－ 443. DOI: 10.3760/cma.j.cn311367－20200415－00231. 毛恩强, 李梦娇. 重症急性胰腺炎早期液体复苏与器官功能维护[J]. 中华消化杂志, 2020, 40( 7): 441－ 443. DOI: 10.3760/cma.j.cn311367－20200415－00231.
[35]	WU J, LU YC, HUANG Z, et al. Effect of abdominal paracentesis drainage on pancreatic pyroptosis of rats with severe acute pancreatitis and its significance[J]. Med J Chin PLA, 2022, 47( 9): 863－ 870. DOI: 10.11855/j.issn.0577－7402.2022.09.0863. 吴俊, 卢一琛, 黄竹, 等. 腹腔穿刺引流对重症急性胰腺炎大鼠胰腺细胞焦亡的影响及其意义[J]. 解放军医学杂志, 2022, 47( 9): 863－ 870. DOI: 10.11855/j.issn.0577－7402.2022.09.0863.
[36]	HANSEN B. Fluid overload[J]. Front Vet Sci, 2021, 8: 668688. DOI: 10.3389/fvets.2021.668688.
[37]	FORGÁCS B, EIBL G, FAULHABER J, et al. Effect of fluid resuscitation with and without endothelin A receptor blockade on hemoconcentration and organ function in experimental pancreatitis[J]. Eur Surg Res, 2000, 32( 3): 162－ 168. DOI: 10.1159/000008758.
[38]	DALFINO L, TULLO L, DONADIO I, et al. Intra－abdominal hypertension and acute renal failure in critically ill patients[J]. Intensive Care Med, 2008, 34( 4): 707－ 713. DOI: 10.1007/s00134－007－0969－4.
[39]	O'CONNOR ME, PROWLE JR. Fluid overload[J]. Crit Care Clin, 2015, 31( 4): 803－ 821. DOI: 10.1016/j.ccc.2015.06.013.
[40]	SUN J, SUN H, SUN Z, et al. Intra－abdominal hypertension and increased acute kidney injury risk: a systematic review and meta－analysis[J]. J Int Med Res, 2021, 49( 5): 3000605211016627. DOI: 10.1177/03000605211016627.
[41]	WANG T, LIU LY, LUO H, et al. Intra－abdominal pressure reduction after percutaneous catheter drainage is a protective factor for severe pancreatitis patients with sterile fluid collections[J]. Pancreas, 2016, 45( 1): 127－ 133. DOI: 10.1097/MPA.0000000000000420.
[42]	GAD MM, SIMONS－LINARES CR. Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta－analysis of randomized control trials and cohort studies[J]. World J Gastroenterol, 2020, 26( 10): 1098－ 1106. DOI: 10.3748/wjg.v26.i10.1098.
[43]	MAO EQ, FEI J, PENG YB, et al. Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis[J]. Chin Med J(Engl), 2010, 123( 13): 1639－ 1644.
[44]	WU BU, HWANG JQ, GARDNER TH, et al. Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2011, 9( 8): 710－ 717. DOI: 10.1016/j.cgh.2011.04.026.

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Efficacy and safety of aggressive fluid resuscitation versus conventional fluid resuscitation in early treatment of acute pancreatitis： A Meta－analysis

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Efficacy and safety of aggressive fluid resuscitation versus conventional fluid resuscitation in early treatment of acute pancreatitis： A Meta－analysis

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