2011CGH_Early Fluid Resuscitation Reduces Morbidity Among Patients-main.pdf

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2011CGH_Early Fluid Resuscitation Reduces Morbidity Among Patients-main.pdf

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2011CGH_Early Fluid Resuscitation Reduces Morbidity Among Patients-main

Br s s a e i CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2011;9:705–709Early Fluid Resuscitation Reduces Morbidity Among Patients With Acute Pancreatitis MATTHEW G. WARNDORF, JANE T. KURTZMAN, MICHAEL J. BARTEL, MOUGNYAN COX, TODD MACKENZIE, SARAH ROBINSON, PAUL R. BURCHARD, STUART R. GORDON, and TIMOTHY B. GARDNERDartmouth-Hitchcock Medical Center, Lebanon, New Hampshire p sPodcast interview: /cghpodcast; see editorial on page 633. ACKGROUND AIMS: Early fluid resuscitation is rec- ommended to reduce morbidity and mortality among patients with acute pancreatitis, although the impact of this interven- tion has not been quantified. We investigated the association between early fluid resuscitation and outcome of patients ad- mitted to the hospital with acute pancreatitis. METHODS: Nontransfer patients admitted to our center with acute pancre- atitis 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 receiv- ing 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 fre- quency of systemic inflammatory response syndrome (SIRS), organ failure, and death. RESULTS: Early resuscitation was associated with decreased SIRS, compared with late resuscita- tion, 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 ate 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 res