title: Early fluid resuscitation reduces morbidity among patients with acute pancreatitis.
abstract: OBJECTIVE
  Early fluid resuscitation is recommended to reduce morbidity and mortality among patients with acute pancreatitis, although the impact of this intervention has not been quantified. We investigated the association between early fluid resuscitation and outcome of patients admitted to the hospital with acute pancreatitis.
  
  
  METHODS
  Nontransfer patients admitted to our center with acute pancreatitis from 1985-2009 were identified retrospectively. Patients were stratified into groups on the basis of early (n = 340) or late resuscitation (n = 94). Early resuscitation was defined as receiving ≥one-third of the total 72-hour fluid volume within 24 hours of presentation, whereas late resuscitation was defined as receiving ≤one-third of the total 72-hour fluid volume within 24 hours of presentation. The primary outcomes were frequency of systemic inflammatory response syndrome (SIRS), organ failure, and death.
  
  
  RESULTS
  Early resuscitation was associated with decreased SIRS, compared with late resuscitation, at 24 hours (15% vs 32%, P = .001), 48 hours (14% vs 33%, P = .001), and 72 hours (10% vs 23%, P = .01), as well as reduced organ failure at 72 hours (5% vs 10%, P < .05), a lower rate of admission to the intensive care unit (6% vs 17%, P < .001), and a reduced length of hospital stay (8 vs 11 days, P = .01). Subgroup analysis demonstrated that these benefits were more pronounced in patients with interstitial rather than severe pancreatitis at admission.
  
  
  CONCLUSIONS
  In patients with acute pancreatitis, early fluid resuscitation was associated with reduced incidence of SIRS and organ failure at 72 hours. These effects were most pronounced in patients admitted with interstitial rather than severe disease.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Warndorf
authors.forename: Jane T
authors.initials: JT
authors.lastname: Kurtzman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bartel
authors.forename: Mougnyan
authors.initials: M
authors.lastname: Cox
authors.forename: Todd
authors.initials: T
authors.lastname: Mackenzie
authors.forename: Sarah
authors.initials: S
authors.lastname: Robinson
authors.forename: Paul R
authors.initials: PR
authors.lastname: Burchard
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Gordon
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Gardner
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome