Fluid resuscitation in the early management of acute pancreatitis – evidence from a systematic review and meta-analysis

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dc.contributor.authorDawson, A.
dc.contributor.authorKarunakaran, M.
dc.contributor.authorSharma, Z.D.
dc.contributor.authorUllah, S.
dc.contributor.authorBarreto, S.G.
dc.date.issued2023
dc.description.abstractBackground: Third space fluid loss is one of the hallmarks of the pathophysiology of acute pancreatitis (AP) contributing to complications, including organ failure and death. We conducted a systematic review of literature to determine the ideal fluid resuscitation in the early management of AP, primarily comparing aggressive versus moderate intravenous fluid resuscitation (AIR vs MIR). Methods: A systematic review of major reference databases was undertaken. Meta-analysis was performed using random-effects model. Bias was assessed using Cochrane risk of bias and ROBINS-I tools for randomized and non-randomised studies, respectively. Results: Twenty studies were included in the analysis. Though there was no significant difference in mortality between AIR and MIR groups (8.3% versus 6.0%; p = 0.3), AIR cohort had significantly higher rates of organ failure (p = 0.009), including pulmonary (p = 0.02) and renal (p = 0.01) complications. Similarly, there was no difference in mortality between normal saline (NS) and Ringer’s lactate (RL) (3.17% versus 3.01%; p = 0.23), though patients treated with NS had a significantly longer length of hospital stay (LOS) (p = 0.009). Conclusions: Current evidence appears to support moderate intravenous resuscitation (level of evidence, low) with RL (level of evidence, moderate) in the early management of AP.
dc.description.statementofresponsibilityAbby Dawson, Monish Karunakaran, Zubin D. Sharma, Shahid Ullah, Savio G. Barreto
dc.identifier.citationHPB, 2023; 25(12):1451-1465
dc.identifier.doi10.1016/j.hpb.2023.08.013
dc.identifier.issn1365-182X
dc.identifier.issn1477-2574
dc.identifier.orcidUllah, S. [0000-0002-1825-7774] [0000-0003-0010-2640]
dc.identifier.urihttps://hdl.handle.net/2440/141863
dc.language.isoen
dc.publisherElsevier BV
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/2021009
dc.rightsCrown Copyright © 2023 Published by Elsevier Ltd on behalf of International Hepato-Pancreato-Biliary Association Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.hpb.2023.08.013
dc.subjectacute pancreatitis
dc.subject.meshHumans
dc.subject.meshPancreatitis
dc.subject.meshAcute Disease
dc.subject.meshIsotonic Solutions
dc.subject.meshFluid Therapy
dc.subject.meshRinger's Lactate
dc.titleFluid resuscitation in the early management of acute pancreatitis – evidence from a systematic review and meta-analysis
dc.typeJournal article
pubs.publication-statusPublished

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