Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis

Buxbaum, James; Quezada, Michael; Da, Ben L.; Jani, Niraj; Lane, Christianne J.; Mwengela, Didi; Kelly, Thomas R.; Jhun, Paul; Dhanireddy, Kiran; Laine, Loren

doi:10.1038/ajg.2017.40

Cited by 113 publications

(108 citation statements)

References 22 publications

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“…One RCT in 60 patients with predicted mild pancreatitis demonstrated that aggressive fluid hydration with Ringer’s lactate (20 mL/kg bolus followed by 3 mL/kg/h) compared with standard hydration with Ringer’s lactate (10 mL/kg bolus followed by 1.5 mL/kg/h) improved a composite end point (ie, ‘clinical improvement within 36 hours’) 19. So, both too little as well as too much fluid administration in the acute phase of pancreatitis can be harmful, possibly dependent on the severity of the pancreatitis.…”

Section: Early Phase Of Acute Pancreatitismentioning

confidence: 99%

Acute pancreatitis: recent advances through randomised trials

Dijk¹,

Hallensleben

Santvoort³

et al. 2017

Gut

359

225

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Acute pancreatitis is one of the most common GI conditions requiring acute hospitalisation and has a rising incidence. In recent years, important insights on the management of acute pancreatitis have been obtained through numerous randomised controlled trials. Based on this evidence, the treatment of acute pancreatitis has gradually developed towards a tailored, multidisciplinary effort, with distinctive roles for gastroenterologists, radiologists and surgeons. This review summarises how to diagnose, classify and manage patients with acute pancreatitis, emphasising the evidence obtained through randomised controlled trials.

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Section: Early Phase Of Acute Pancreatitismentioning

confidence: 99%

Acute pancreatitis: recent advances through randomised trials

Dijk¹,

Hallensleben

Santvoort³

et al. 2017

Gut

359

225

View full text Add to dashboard Cite

show abstract

“…From multiple adult studies it can be concluded that aggressive resuscitation is associated with improved outcomes in AP, but overresuscitation should be avoided. A regimen of IV fluids within 4 hours of diagnosis to aggressive (20 ml/kg bolus followed by 3 ml/kg/h) vs. standard (10 ml/kg bolus followed by 1.5 mg/kg/h) hydration with lactated Ringer's solution was associated with greater rate of clinical improvement 75 .…”

mentioning

confidence: 93%

EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis

et al. 2018

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“…Unfortunately, diversity of inclusion criterion makes it challenging to identify which groups of patients benefit from specific therapy. Additionally, while objective acute pancreatitis outcomes such as death are fortunately rare this necessitates the use of surrogate measures such as clinical improvement or changes in cytokine levels as study endpoints [1, 5]. The use of scoring systems that predict severity of disease have predominated in the acute pancreatitis field.…”

Section: Introductionmentioning

confidence: 99%

The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study

Buxbaum

Quezada

Chong

et al. 2018

American Journal of Gastroenterology

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OBJECTIVES: The Pancreatitis Activity Scoring System (PASS) has been derived by an international group of experts via a modified Delphi process. Our aim was to perform an external validation study to assess for concordance of the PASS score with high face validity clinical outcomes and determine specific meaningful thresholds to assist in application of this scoring system in a large prospectively ascertained cohort. METHODS: We analyzed data from a prospective cohort study of consecutive patients admitted to the Los Angeles County Hospital between March 2015 and March 2017. Patients were identified using an emergency department paging system and electronic alert system. Comprehensive characterization included substance use history, pancreatitis etiology, biochemical profile, and detailed clinical course. We calculated the PASS score at admission, discharge, and at 12 h increments during the hospitalization. We performed several analyses to assess the relationship between the PASS score and outcomes at various points during hospitalization as well as following discharge. Using multivariable logistic regression analysis, we assessed the relationship between admission PASS score and risk of severe pancreatitis. PASS score performance was compared to established systems used to predict severe pancreatitis. Additional inpatient outcomes assessed included local complications, length of stay, development of systemic inflammatory response syndrome (SIRS), and intensive care unit (ICU) admission. We also assessed whether the PASS score at discharge was associated with early readmission (re-hospitalization for pancreatitis symptoms and complications within 30 days of discharge). RESULTS: A total of 439 patients were enrolled, their mean age was 42 (±15) years, and 53% were male. Admission PASS score >140 was associated with moderately severe and severe pancreatitis (OR 3.5 [95% CI 2.0, 6.3]), ICU admission (OR 4.9 [2.5, 9.4]), local complications (3.0 [1.6, 5.7]), and development of SIRS (OR 2.9 [1.8, 4.5]) as well as prolongation of hospitalization by a mean of 1.5 (1.3–1.7) days. For the prediction of moderately severe/severe pancreatitis, the PASS score (AUC = 0.71) was comparable to the more established Ranson’s (AUC = 0.63), Glasgow (AUC = 0.72), Panc3 (AUC = 0.57), and HAPS (AUC = 0.54) scoring systems. Discharge PASS score >60 was associated with early readmission (OR 5.0 [2.4, 10.7]). CONCLUSIONS: The PASS score is associated with important clinical outcomes in acute pancreatitis. The ability of the score to forecast important clinical events at different points in the disease course suggests that it is a valid measure of activity in patients with acute pancreatitis.

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Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis

Abstract: Early aggressive intravenous hydration with Lactated Ringer's solution hastens clinical improvement in patients with mild acute pancreatitis.

Cited by 113 publications

References 22 publications

Acute pancreatitis: recent advances through randomised trials

Acute pancreatitis: recent advances through randomised trials

EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis

The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study

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