title: Detrimental effect of high volume fluid administration in acute pancreatitis - a retrospective analysis of 391 patients.
abstract: BACKGROUND
  Early fluid resuscitation is recommended for the therapy of acute pancreatitis in order to prevent complications. There are, however, no convincing data supporting this approach.
  
  
  METHODS
  We reviewed 391 consecutive cases of confirmed acute pancreatitis. Admitting physicians had been advised to administer an aggressive fluid resuscitation in the early phase of disease, if possible. We tested whether disease severity according to the revised Atlanta Classification, local complications, and maximum C-reactive protein levels were predictable by the initial volume therapy in logistic and linear regression models, respectively. We also determined which parameters on admission encouraged a more aggressive fluid resuscitation.
  
  
  RESULTS
  The recorded fluid administered within the first 24 h was 5300 [3760; 7100] ml (median [1st; 3rd quartile]). More aggressive volume therapy was associated with disease severity and a higher rate of local complications. There was a linear relationship between administered volume and the maximum C-reactive protein. The amount of administered fluid was significantly attributed to age, hematocrit, and white blood cell count on admission. When adjusted for these parameters the impact of administered volume on outcome was still present but attenuated.
  
  
  CONCLUSIONS
  We found detrimental effects of fluid therapy on major outcome parameters throughout the whole range of administered volume. More volume was administered in younger patients and in patients with evidence of hemoconcentration and inflammation. The adverse effects of volume therapy persisted after elimination of these parameters. Caution should therefore be advised with regards to volume therapy in patients with acute pancreatitis.
authors.affiliation: Medical Department I, Gastroenterology, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. Electronic address: gunther.weitz@uksh.de.
authors.forename: Gunther
authors.initials: G
authors.lastname: Weitz
authors.affiliation: Medical Department I, Gastroenterology, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Woitalla
authors.affiliation: Medical Department I, Gastroenterology, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wellhöner
authors.affiliation: Medical Department I, Gastroenterology, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Schmidt
authors.affiliation: Medical Department I, Gastroenterology, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Büning
authors.affiliation: Medical Department I, Gastroenterology, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Fellermann
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods*; D006400:Hematocrit; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010195:Pancreatitis / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein
keywords: Acute pancreatitis; Disease severity; Fluid resuscitation; Local complications; Outcome; Volume therapy