title: Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study.
abstract: OBJECTIVE
  Although aggressive fluid therapy during the first days of hospitalization is recommended by most guidelines and reviews on acute pancreatitis (AP), this recommendation is not supported by any direct evidence. We aimed to evaluate the association between the amount of fluid administered during the initial 24 h of hospitalization and the incidence of organ failure (OF), local complications, and mortality.
  
  
  METHODS
  This was a prospective cohort study. We included consecutive adult patients admitted with AP. Local complications and OF were defined according to the Atlanta Classification. Persistent OF was defined as OF of >48-h duration. Patients were divided into three groups according to the amount of fluid administered during the initial 24 h: group A: <3.1 l (less than the first quartile), group B: 3.1-4.1 l (between the first and third quartiles), and group C: >4.1 l (more than the third quartile).
  
  
  RESULTS
  A total of 247 patients were analyzed. Administration of >4.1 l during the initial 24 h was significantly and independently associated with persistent OF, acute collections, respiratory insufficiency, and renal insufficiency. Administration of <3.1 l during the initial 24 h was not associated with OF, local complications, or mortality. Patients who received between 3.1 and 4.1 l during the initial 24 h had an excellent outcome.
  
  
  CONCLUSIONS
  In our study, administration of a small amount of fluid during the initial 24 h was not associated with a poor outcome. The need for a great amount of fluid during the initial 24 h was associated with a poor outcome; therefore, this group of patients must be carefully monitored.
authors.affiliation: Pancreatic Unit, Hospital General Universitario de Alicante, Spain. madaria@hotmail.com
authors.forename: Enrique
authors.initials: E
authors.lastname: de-Madaria
authors.forename: Gema
authors.initials: G
authors.lastname: Soler-Sala
authors.forename: José
authors.initials: J
authors.lastname: Sánchez-Payá
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Lopez-Font
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez
authors.forename: Laura
authors.initials: L
authors.lastname: Gómez-Escolar
authors.forename: Laura
authors.initials: L
authors.lastname: Sempere
authors.forename: Cristina
authors.initials: C
authors.lastname: Sánchez-Fortún
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-Mateo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome