Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Lan Li, Tao Jin, Si Wen, Na Shi, Ruwen Zhang, Ping Zhu, Ziqi Lin, Kun Jiang, Jia Guo, Tingting Liu, Anthony Philips, Lihui Deng, Xiaonan Yang, Vikesh K. Singh, Robert Sutton, John A. Windsor, Wei Huang, Qing Xia

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Abstract

Background/Aims: Hematocrit is a widely used biomarker to guide early fluid therapy for patients with acute pancreatitis (AP), but there is controversy over whether early rapid fluid therapy (ERFT) should be used in hemoconcentrated patients. This study investigated the association of hematocrit and ERFT with clinical outcomes of patients with AP. Methods: Data from prospectively maintained AP database and retrospectively collected fluid management details were stratified according to actual severity defined by revised Atlanta classification. Hemoconcentration and “early” were defined as hematocrit > 44% and the first 6 h of general ward admission, respectively, and “rapid” fluid rate was defined as ≥ 3 ml/kg/h. Patients were allocated into 4 groups for comparisons: group A, hematocrit ≤ 44% and fluid rate < 3 ml/kg/h; group B, hematocrit ≤ 44% and fluid rate ≥ 3 ml/kg/h; group C, hematocrit > 44% and fluid rate < 3 ml/kg/h; and group D, hematocrit > 44% and fluid rate ≥ 3 ml/kg/h. Primary outcome was rate of noninvasive positive-pressure ventilation (NPPV). Results: A total of 912 consecutive AP patients were analyzed. ERFT has no impact on clinical outcomes of hemoconcentrated, non-severe or all non-hemoconcentrated AP patients. In hemoconcentrated patients with severe AP (SAP), ERFT was accompanied with increased risk of NPPV (odds ratio 5.96, 95% CI 1.57–22.6). Multivariate regression analyses confirmed ERFT and hemoconcentration were significantly and independently associated with persistent organ failure and mortality in patients with SAP. Conclusions: ERFT is associated with increased rate of NPPV in hemoconcentrated patients with SAP.

Original languageEnglish (US)
JournalDigestive diseases and sciences
DOIs
StateAccepted/In press - Jan 1 2020

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Keywords

  • Acute pancreatitis
  • Fluid therapy
  • Hemoconcentration
  • Noninvasive positive-pressure ventilation
  • Persistent organ failure

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Li, L., Jin, T., Wen, S., Shi, N., Zhang, R., Zhu, P., Lin, Z., Jiang, K., Guo, J., Liu, T., Philips, A., Deng, L., Yang, X., Singh, V. K., Sutton, R., Windsor, J. A., Huang, W., & Xia, Q. (Accepted/In press). Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis. Digestive diseases and sciences. https://doi.org/10.1007/s10620-019-05985-w