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

• Published in: Digestive diseases and sciences Vol. 65; no. 9; pp. 2700 - 2711
• Main Authors: Li, Lan, Jin, Tao, Wen, Si, Shi, Na, Zhang, Ruwen, Zhu, Ping, Lin, Ziqi, Jiang, Kun, Guo, Jia, Liu, Tingting, Philips, Anthony, Deng, Lihui, Yang, Xiaonan, Singh, Vikesh K., Sutton, Robert, Windsor, John A., Huang, Wei, Xia, Qing
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2020; Springer; Springer Nature B.V
• Subjects: Acute Disease; Adult; Aged; Analysis; Biochemistry; Care and treatment; China; Clinical Decision-Making; Clinical outcomes; Clinical trials; Databases, Factual; Female; Fluid Therapy - adverse effects; Gastroenterology; Health aspects; Hematocrit; Hepatology; Humans; Hydration; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Metabolism; Middle Aged; Mortality; Noninvasive Ventilation - adverse effects; Oncology; Original; Original Article; Pancreatitis; Pancreatitis - blood; Pancreatitis - diagnosis; Pancreatitis - therapy; Positive-Pressure Respiration - adverse effects; Predictive Value of Tests; Respiration Disorders - diagnosis; Respiration Disorders - physiopathology; Respiration Disorders - therapy; Retrospective Studies; Risk Assessment; Risk Factors; Sepsis; Severity of Illness Index; Time Factors; Transplant Surgery; Treatment Outcome; Ventilation; Ventilators; Young Adult; China; Fluid therapy; Persistent organ failure; Acute pancreatitis; Noninvasive positive-pressure ventilation; Hemoconcentration
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05985-w

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.