title: Early crystalloid fluid volume management in acute pancreatitis: association with mortality and organ failure.
abstract: OBJECTIVE
  Guidelines recommend aggressive fluid resuscitation in patients with acute pancreatitis (AP) to minimize organ failure. This study aimed to determine whether early crystalloid fluid management is associated with mortality and/or critical care.
  
  
  METHODS
  9,489 AP patients aged ≥18 years were categorized into four study groups: ventilation, hemodialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. We analyzed demographics, mortality, comorbidities, complications, AP severity, surgery of the biliary/pancreatic system, and fluid volume (FV) during the initial 48 h (FV48) and during hospitalization (FVH), and calculated the FV ratio (FVR) as FV48/FVH. The impact of FV48 and FVR on mortality and the care process was assessed according to AP severity.
  
  
  RESULTS
  1.1% of AP patients received ventilation, 1.7% received hemodialysis and 1.0% received both treatments. FV48 and FVR were higher in patients requiring ventilation compared with those not requiring ventilation. A high FV48 increased mortality and a high FVR decreased mortality in patients with severe AP. A high FV48 required ventilation in patients with severe AP, which was independently associated with mortality.
  
  
  CONCLUSIONS
  Since relatively too much or too little early FV is associated with mortality, FV should be continuously monitored and managed according to AP severity. and IAP.
authors.affiliation: Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Koichi B
authors.initials: KB
authors.lastname: Ishikawa
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujimori
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015897:Comorbidity; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D010195:Pancreatitis / Q000150:complications / Q000191:economics / Q000401:mortality / Q000628:therapy*; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D014662:Vasoconstrictor Agents