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Large Volume Fluid Resuscitation for Severe Acute Pancreatitis is Associated With Reduced Mortality

A Multicenter Retrospective Study

Yamashita, Takahiro, MD*,†; Horibe, Masayasu, MD‡,§; Sanui, Masamitsu, MD, PhD; Sasaki, Mitsuhito, MD; Sawano, Hirotaka, MD, PhD#; Goto, Takashi, MD**; Ikeura, Tsukasa, MD, PhD††; Hamada, Tsuyoshi, MD, PhD‡‡; Oda, Takuya, MD§§; Yasuda, Hideto, MD∥∥; Ogura, Yuki, MD, PhD§; Miyazaki, Dai, MD¶¶; Hirose, Kaoru, MD##; Kitamura, Katsuya, MD, PhD***; Chiba, Nobutaka, MD, PhD†††; Ozaki, Tetsu, MD‡‡‡; Koinuma, Toshitaka, MD§§§; Oshima, Taku, MD, PhD∥∥∥; Yamamoto, Tomonori, MD, PhD¶¶¶; Hirota, Morihisa, MD, PhD###; Masuda, Yukiko, MD****; Tokuhira, Natsuko, MD††††; Kobayashi, Mioko, MD‡‡‡‡; Saito, Shinjiro, MD§§§§; Izai, Junko, MD∥∥∥∥; Lefor, Alan K., MD, MPH, PhD¶¶¶¶; Iwasaki, Eisuke, MD, PhD; Kanai, Takanori, MD, PhD; Mayumi, Toshihiko, MD, PhD####

Journal of Clinical Gastroenterology: May/June 2019 - Volume 53 - Issue 5 - p 385–391
doi: 10.1097/MCG.0000000000001046

Background and Aims: Although fluid resuscitation is critical in acute pancreatitis, the optimal fluid volume is unknown. The aim of this study is to evaluate the association between the volume of fluid administered and clinical outcomes in patients with severe acute pancreatitis (SAP).

Methods: We conducted a multicenter retrospective study at 44 institutions in Japan. Inclusion criteria were age 18 years or older, and diagnosed with SAP from 2009 to 2013. Patients were stratified into 2 groups: administered fluid volume <6000 and ≥6000 mL in the first 24 hours. We evaluated the association between the 2 groups and clinical outcomes using multivariable logistic regression analysis. The primary outcome was in-hospital mortality. Secondary outcomes included the incidence of pancreatic infection and the need for surgical intervention.

Results: We analyzed 1097 patients, and the mean fluid volume administered was 5618±3018 mL (mean±SD), with 708 and 389 patients stratified into the fluid <6000 mL and fluid ≥6000 mL groups, respectively. Overall in-hospital mortality was 12.3%. The fluid ≥6000 mL group had significantly higher mortality than the fluid <6000 mL group (univariable analysis, 15.9% vs. 10.3%; P<0.05). In multivariable logistic regression analysis, administration of ≥6000 mL of fluid within the first 24 hours was significantly associated with reduced mortality (odds ratio, 0.58; P<0.05). No significant association was found between the administered fluid volume and pancreatic infection, or between the volume administered and the need for surgical intervention.

Conclusions: In patients with SAP, administration of a large fluid volume within the first 24 hours is associated with decreased mortality.

*Emergency Medical Center, Fukuyama City Hospital, Zao-cho, Fukuyama City

**Department of Anesthesiology and Intensive Care, Hiroshima City Hiroshima Citizens Hospital, Motomachi, Naka-ku, Hiroshima City, Hiroshima

Acute Care Medical Center, Hyogo Prefectural Kakogawa Medical Center, Kanno-cho, Kakogawa City, Hyogo

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku-ku

§Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Musashidai, Fuchu City

Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tsukiji, Chuo-ku

‡‡Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku

∥∥Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Kyounancho, Musashino City

***Division of Gastroentelology, Department of Medicine, Showa University School of Medicine, Hatanodai, Shinagawa-ku

†††Department of Emergency and Critical Care Medicine, Nihon University Hospital, Kanda-Surugadai, Chiyoda-ku

‡‡‡‡Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Kotobashi, Sumida-ku

§§§§Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Nishi-Shinbashi, Minato-ku, Tokyo

Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Amanumacho, Omiya-ku, Saitama

#Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Tsukumodai, Suita

††The Third Department of Internal Medicine, Kansai Medical University, Shinmachi, Hirakata

¶¶¶Department of Traumatology and Critical Care Medicine, Osaka City University, Asahimachi, Abenoku, Osaka City, Osaka

§§Department of General Internal Medicine, Iizuka Hospital, Yoshiomachi, Iizuka-shi

####Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Iseigaoka, Yahata Nishi, KitaKyushu, Fukuoka

¶¶Advanced Emergency Medical and Critical Care Center, Japanese Red Cross Maebashi Hospital, Asahi-cho, Maebashi City, Gunma

##Department of Emergency Medicine, Shonan Kamakura General Hospital, Okamoto, Kamakura City, Kanagawa

‡‡‡Department of Acute care and General Medicine, Saiseikai Kumamoto Hospital, Chikami, minami-ku, Kumamoto city, Kumamoto

§§§Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine

¶¶¶¶Department of Surgery, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi

∥∥∥Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba City, Chiba

###Division of Gastroenterology, Tohoku University Hospital, Seiryo-cho, Aoba-ku

∥∥∥∥Department of Surgery, Saka General Hospital, Nishiki-cho, Shiogama City, Miyagi

****Emergency and Critical Care Center, National Hospital Organization Nagasaki Medical Center, Kubara, Omura, Nagasaki

††††Division of Intensive Care Medicine, University Hospital, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan

T.Yamashita, M.Horibe, M.Sanui, and M.Sasaki: literature search. M.Horibe, M.Sanui, M.Sasaki, and T.M.: study concept and design. T.Yamashita, M.Horibe, M.Sanui, M.Sasaki, H.S., T.G., T.I., T.H., T.Oda, H.Y., Y.O., D.M., K.H., K.K., N.C., T.Ozaki, T.Koinuma, T.Oshima, T.Yamamoto, M.Hirota, Y.M., N.T., M.K., S.S., J.I., E.I., T.Kanai, and T.M.: acquisition of data. T.Yamashita, M.Horibe, and M.Sanui: analysis and interpretation of data. T.Yamashita, M.Horibe, M.Sanui, E.I., M.Hirota, T.Oshima, and A.K.L.: drafting of the manuscript. T.Yamashita and M.Horibe: drafting tables and figures. T.Yamashita, M.Horibe, M.Sanui, M.Sasaki, H.S., T.G., T.I., T.H., T.Oda, H.Y., Y.O., D.M., K.H., K.K., N.C., T.Ozaki, T.Koinuma, T.Oshima, T.Yamamoto, M.Hirota, Y.M., N.T., M.K., S.S., J.I., A.K.L., E.I., T.Kanai, and T.M.: critical revision of the manuscript for important intellectual content.

The authors declare that they have nothing to disclose.

Address correspondence to: Masamitsu Sanui, MD, PhD, Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumachou, Omiya-ku, Saitama, Saitama 330-8503, Japan (e-mail:

Received December 9, 2017

Accepted March 15, 2018

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