Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis.
Acute Disease
Adult
Aged
China
Clinical Decision-Making
Databases, Factual
Female
Fluid Therapy
/ adverse effects
Hematocrit
Humans
Male
Middle Aged
Noninvasive Ventilation
/ adverse effects
Pancreatitis
/ blood
Positive-Pressure Respiration
/ adverse effects
Predictive Value of Tests
Respiration Disorders
/ diagnosis
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Young Adult
Acute pancreatitis
Fluid therapy
Hemoconcentration
Noninvasive positive-pressure ventilation
Persistent organ failure
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
15
09
2019
accepted:
27
11
2019
pubmed:
9
1
2020
medline:
30
12
2020
entrez:
9
1
2020
Statut:
ppublish
Résumé
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. 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). 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. ERFT is associated with increased rate of NPPV in hemoconcentrated patients with SAP.
Sections du résumé
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.
Identifiants
pubmed: 31912265
doi: 10.1007/s10620-019-05985-w
pii: 10.1007/s10620-019-05985-w
pmc: PMC7419345
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2700-2711Subventions
Organisme : Department of Health
ID : EME/15/20/01
Pays : United Kingdom
Organisme : Ministry of Science and Technology
ID : 2016YFE0101800
Pays : International
Commentaires et corrections
Type : CommentIn
Références
Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.
pubmed: 23100216
Shi N, Liu T, de la Iglesia D, et al. Duration of organ failure impacts mortality in acute pancreatitis. Gut 2019, gutjnl-2019-318241.
Parniczky A, Kui B, Szentesi A, et al. Prospective, multicentre, nationwide clinical data from 600 cases of acute pancreatitis. PLoS One. 2016;11:e0165309.
pubmed: 27798670
pmcid: 5087847
Moggia E, Koti R, Belgaumkar AP, et al. Pharmacological interventions for acute pancreatitis. Cochrane Database Syst Rev. 2017;4:CD011384.
pubmed: 28431202
Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108:1400–1416.
pubmed: 23896955
Working Group IAPAPAAPG. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:e1–e15.
Haydock MD, Mittal A, Wilms HR, et al. Fluid therapy in acute pancreatitis: anybody’s guess. Ann Surg. 2013;257:182–188.
pubmed: 23207241
Warndorf MG, Kurtzman JT, Bartel MJ, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011;9:705–709.
pubmed: 21554987
pmcid: 3143229
Dimagno MJ, Wamsteker EJ, Rizk RS, et al. A combined paging alert and web-based instrument alters clinician behavior and shortens hospital length of stay in acute pancreatitis. Am J Gastroenterol. 2014;109:306–315.
pubmed: 24594946
pmcid: 5565843
Singh VK, Gardner TB, Papachristou GI, et al. An international multicenter study of early intravenous fluid administration and outcome in acute pancreatitis. United European Gastroenterol J. 2017;5:491–498.
pubmed: 28588879
Buxbaum JL, Quezada M, Da B, et al. Early aggressive hydration hastens clinical improvement in mild acute pancreatitis. Am J Gastroenterol. 2017;112:797–803.
pubmed: 28266591
Weitz G, Woitalla J, Wellhoner P, et al. Detrimental effect of high volume fluid administration in acute pancreatitis: a retrospective analysis of 391 patients. Pancreatology. 2014;14:478–483.
pubmed: 25451185
de Madaria E, Soler-Sala G, Sanchez-Paya J, et al. Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol. 2011;106:1843–1850.
Ke L, Ni HB, Sun JK, et al. Risk factors and outcome of intra-abdominal hypertension in patients with severe acute pancreatitis. World J Surg. 2012;36:171–178.
pubmed: 21964817
Mao EQ, Tang YQ, Fei J, et al. Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl). 2009;122:169–173.
Mao EQ, Fei J, Peng YB, et al. Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis. Chin Med J (Engl). 2010;123:1639–1644.
Yokoe M, Takada T, Mayumi T, et al. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci. 2015;22:405–432.
pubmed: 25973947
Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on initial management of acute pancreatitis. Gastroenterology. 2018;154:1096–1101.
pubmed: 29409760
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–1377.
pubmed: 11794169
Investigators A, Group ACT, Peake SL, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496–506.
Pro CI, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370:1683–1693.
Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372:1301–1311.
pubmed: 25776532
Wilms H, Mittal A, Haydock MD, et al. A systematic review of goal directed fluid therapy: rating of evidence for goals and monitoring methods. J Crit Care. 2014;29:204–209.
pubmed: 24360819
Jin T, Jiang K, Deng L, et al. Response and outcome from fluid resuscitation in acute pancreatitis: a prospective cohort study. HPB (Oxford). 2018;20:1082–1091.
Haydock MD, Mittal A, van den Heever M, et al. National survey of fluid therapy in acute pancreatitis: current practice lacks a sound evidence base. World J Surg. 2013;37:2428–2435.
pubmed: 23720122
Gray SH, Rosenman LD. Acute pancreatitis. The significance of hemoconcentration at admission to the hospital. Arch Surg. 1965;91:485–489.
pubmed: 14332409
Baillargeon JD, Orav J, Ramagopal V, et al. Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol. 1998;93:2130–2134.
pubmed: 9820385
Brown A, Orav J, Banks PA. Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas. 2000;20:367–372.
pubmed: 10824690
Brown A, Baillargeon JD, Hughes MD, et al. Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis? Pancreatology. 2002;2:104–107.
pubmed: 12123089
Wu BU, Johannes RS, Conwell DL, et al. Early hemoconcentration predicts increased mortality only among transferred patients with acute pancreatitis. Pancreatology. 2009;9:639–643.
pubmed: 19657219
Koutroumpakis E, Wu BU, Bakker OJ, et al. Admission hematocrit and rise in blood urea nitrogen at 24 h outperform other laboratory markers in predicting persistent organ failure and pancreatic necrosis in acute pancreatitis: a post hoc analysis of three large prospective databases. Am J Gastroenterol. 2015;110:1707–1716.
pubmed: 26553208
von Elm E, Altman DG, Egger M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335:806–808.
Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795–1815.
pubmed: 25392034
pmcid: 4239778
Zhao X, Huang W, Li J, et al. Noninvasive positive-pressure ventilation in acute respiratory distress syndrome in patients with acute pancreatitis: a retrospective cohort study. Pancreas. 2016;45:58–63.
pubmed: 26132548
Zhang R, Deng L, Jin T, et al. Hypertriglyceridaemia-associated acute pancreatitis: diagnosis and impact on severity. HPB (Oxford). 2019;21:1240–1249.
pubmed: 30885545
Mukherjee R, Nunes Q, Huang W, et al. Precision medicine for acute pancreatitis: current status and future opportunities. Precision Clinical Medicine. 2019;2:81–86.
Force ADT, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: The Berlin Definition. JAMA. 2012;307:2526–2533.
Beitler JR, Schoenfeld DA, Thompson BT. Preventing ARDS: Progress, promise, and pitfalls. Chest. 2014;146:1102–1113.
pubmed: 25288000
pmcid: 4188145
Hashimoto S, Sanui M, Egi M, et al. The clinical practice guideline for the management of ARDS in Japan. J Intensive Care. 2017;5:50.
pubmed: 28770093
pmcid: 5526253
Wu BU. Editorial: fluid resuscitation in acute pancreatitis: Striking the right balance. Am J Gastroenterol. 2011;106:1851–1852.
pubmed: 21979206
Stigliano S, Sternby H, de Madaria E, et al. Early management of acute pancreatitis: A review of the best evidence. Dig Liver Dis. 2017;49:585–594.
pubmed: 28262458
Schumacker PT, Cain SM. The concept of a critical oxygen delivery. Intensive Care Med. 1987;13:223–229.
pubmed: 3301969
Cabrales P, Tsai AG, Frangos JA, et al. Oxygen delivery and consumption in the microcirculation after extreme hemodilution with perfluorocarbons. Am J Physiol Heart Circ Physiol. 2004;287:H320–H330.
pubmed: 15210452
Morariu AM, Maathuis MH, Asgeirsdottir SA, et al. Acute isovolemic hemodilution triggers proinflammatory and procoagulatory endothelial activation in vital organs: Role of erythrocyte aggregation. Microcirculation. 2006;13:397–409.
pubmed: 16815825
Liu T, Huang W, Szatmary P, et al. Accuracy of circulating histones in predicting persistent organ failure and mortality in patients with acute pancreatitis. Br J Surg. 2017;104:1215–1225.
pubmed: 28436602
Schepers NJ, Bakker OJ, Besselink MG, et al. Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis. Gut. 2019;68:1044–1051.
pubmed: 29950344
Wang YM, Tao YH. Mechanical ventilation in acute respiratory distress syndrome. Zhongguo Dang Dai Er Ke Za Zhi. 2013;15:496–501.
pubmed: 23791070
Young D, Lamb SE, Shah S, et al. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med. 2013;368:806–813.
pubmed: 23339638
Hess DR. The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature. Respir Care. 2004;49:810–829.
pubmed: 15222912