title: Early factors associated with fluid sequestration and outcomes of patients with acute pancreatitis.
abstract: OBJECTIVE
  Predicting level of fluid sequestration could help identify patients with acute pancreatitis (AP) who need more or less aggressive fluid resuscitation. We investigated factors associated with level of fluid sequestration in the first 48 hours after hospital admission in patients with AP and effects on outcome.
  
  
  METHODS
  We analyzed data from consecutive adult patients with AP admitted to the Brigham and Women's Hospital in Boston, Massachusetts, from June 2005 to December 2007 (n = 266) or the Alicante University General Hospital in Spain from September 2010 to December 2012 (n = 137). Level of fluid sequestration in the first 48 hours after hospital admission was calculated by subtracting the total amount of fluid administered and lost in the first 48 hours of hospitalization. Demographic and clinical variables obtained in the emergency department were analyzed to identify factors associated with level of fluid sequestration in the first 48 hours after hospital admission. Outcome assessed included length of hospital stay, acute fluid collection(s), pancreatic necrosis, persistent organ failure, and mortality.
  
  
  RESULTS
  The median level of fluid sequestration in the first 48 hours after hospital admission was 3.2 L (1.4-5 L). The simple and multiple linear regression models showed that younger age, alcohol etiology, hematocrit, glucose, and systemic inflammatory response syndrome were significantly associated with increased levels of fluid sequestration in the first 48 hours after hospital admission. Increased level of fluid sequestration in the first 48 hours was significantly associated with longer hospital stays and higher rates of acute fluid collection, pancreatic necrosis, and persistent organ failure. There was a nonsignificant trend toward a higher level of fluid sequestration in the first 48 hours among patients who died.
  
  
  CONCLUSIONS
  Age, alcoholic etiology of AP, hematocrit, glucose, and presence of systemic inflammatory response syndrome in the emergency department were independent predictors of increased levels of fluid sequestration in the first 48 hours after hospital admission. These patients have higher risks of local and systemic complications and longer hospital stays.
authors.affiliation: Pancreatic Unit, Hospital General Universitario de Alicante, Alicante, Spain. Electronic address: madaria@hotmail.com.
authors.forename: Enrique
authors.initials: E
authors.lastname: de-Madaria
authors.affiliation: Center for Pancreatic Disease, Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Banks
authors.affiliation: Pancreatic Unit, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Neftalí
authors.initials: N
authors.lastname: Moya-Hoyo
authors.affiliation: Center for Pancreatic Disease, Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Pancreatic Care, Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
authors.forename: Bechien U
authors.initials: BU
authors.lastname: Wu
authors.affiliation: Pancreatic Unit, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Rey-Riveiro
authors.affiliation: Pancreatic Unit, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Nelly G
authors.initials: NG
authors.lastname: Acevedo-Piedra
authors.affiliation: Pancreatic Unit, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez
authors.affiliation: Pancreatic Unit, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Lluís
authors.affiliation: Preventative Medicine, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Sánchez-Payá
authors.affiliation: Center for Pancreatic Disease, Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D001900:Boston; D015331:Cohort Studies; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D013030:Spain; D016019:Survival Analysis; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy
keywords: Intravenous Fluid Therapy; Management; Morbidity; Pancreatic Inflammation; Treatment