Fluid resuscitation in the early management of acute pancreatitis: a five-year retrospective observational study

doi:10.5847/wjem.j.1920-8642.2026.051

Abstract

Abstract:

BACKGROUND: Early intravenous fluid (IVF) resuscitation is critical to the management of acute pancreatitis (AP). Nonetheless, the optimal fluid type, infusion rate, and volume remain subjects of debate in clinical practice. This study aimed to investigate the dosage and rate of early intravenous fluid (IVF) resuscitation on the prognosis and complications of AP.

METHODS: This study included patients diagnosed with AP who were admitted to Zhongshan Hospital, Fudan University, between December 1, 2018, and December 1, 2022. Patients were classified into mild and non-mild groups according to the Atlanta criteria. Clinical data, including the dosage of IVF resuscitation within 24 h after admission, complications, and clinical prognosis, were collected. Systemic complications, including in-hospital mortality, endotracheal intubation, renal replacement therapy, and secondary infection, were defined as composite endpoint 1. Local complications, including the peripancreatic fluid accumulation, local drainage, and pseudocyst formation, were defined as composite endpoint 2. Risk factors associated with these endpoints were identified via multivariate logistic regression.

RESULTS: A total of 527 AP patients were enrolled. The IVF dosage in the first 24 h was significantly higher in the non-mild group (62.48 [54.06, 72.99] mL/kg vs. 54.21 [45.88, 62.23] mL/kg, P<0.001) compared with the mild group. Sequential Organ Failure Assessment (SOFA) and the dosage of IVF were identified as independent risk factors for both systemic complications (SOFA: OR 2.477 [95%CI 1.464-4.189], P<0.001; IVF: OR 1.058 [95%CI 1.015-1.102], P=0.0082) and local complications (SOFA: OR 1.545 [95%CI 1.266-1.887], P<0.001; IVF: OR 1.035 [95%CI 1.017-1.053], P<0.001). According to the ROC curve, the optimal cutoff value for the dose of IVF resuscitation was 69.89 mL/kg (2.9 mL/[kg·h]). Further stratified analysis revealed stepwise increases in IVF rates across SOFA groups (SOFA<2, SOFA 2-4, and SOFA>4).

CONCLUSION: The early IVF resuscitation was associated with both systemic and local complications of AP, supporting a shift from “empirical” to “precisely prescribed” IVF therapy in the managment of AP.

Key words: Acute pancreatitis, Early intravenous fluid resuscitation, Systemic complications, Local complications

Lulu Lan, Guo Cheng, Meijie He, Min Min, Chaoyang Tong, Shilin Du, Xin Li, Yi Han. Fluid resuscitation in the early management of acute pancreatitis: a five-year retrospective observational study[J]. World Journal of Emergency Medicine, 2026, 17(3): 230-236.

Figures/Tables 5

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Variables	Mild (n=422)	Non-mild (n=105)	P-value
Gender, n (%)			0.579
Male	265 (62.8)	69 (65.7)
Female	157 (37.2)	36 (34.3)
Age, years	55 (39, 65)	57 (42, 68)	0.141
Body mass index, kg/m²	25.79 (24.16, 27.06)	25.47 (24.00, 26.95)	0.133
Medical history, n (%)
Hypertension	132 (31.3)	29 (27.6)	0.466
Diabetes mellitus	94 (22.3)	39 (37.1)	0.002
Coronary heart disease	32 (7.6)	10 (9.5)	0.511
Respiratory disease	20 (4.7)	5 (4.8)	1.000
Liver disease	15 (3.6)	5 (4.8)	0.769
Autoimmune disease	10 (2.4)	3 (2.9)	1.000
Malignancy	37 (8.8)	6 (5.7)	0.306
Etiology, n (%)			0.003
Gallstones	131 (31.0)	39 (37.1)
Hypertriglyceridemia	79 (18.7)	33 (31.4)
Miscellaneous	186 (44.1)	30 (28.6)
Other etiology	26 (6.2)	3 (2.9)
SOFA	1 (0, 1)	2 (0, 3)	<0.001
WBC, ×10⁹/L	9.92 (6.83, 13.46)	11.77 (8.91, 15.72)	<0.001
CRP, mg/L	40.7 (18.1, 84.3)	65.3 (22.8, 90.0)	0.002
Ca²⁺, mmol/L	2.21 (2.14, 2.29)	2.25 (2.13, 2.30)	0.608
PLT, ×10⁹/L	274 (237, 301)	275 (205, 307)	0.827
TB, mmol/L	15.6 (12.2, 19.3)	18.5 (12.3, 28.0)	0.004
Cr, μmol/L	58 (49, 68)	59 (53, 78)	0.002
P/F ratio, mmHg	375 (331, 412)	347 (322, 412)	0.023
Dose of IVF, mL/kg	54.21 (45.88, 63.23)	62.28 (54.06, 72.99)	<0.001
Length of hospital stay, d	10 (8,13)	16 (12, 22.5)	<0.001
Systemic complications, n (%)
Mortality	0 (0.0)	2 (1.9)	0.051
Secondary infection	3 (0.7)	11 (10.5)	<0.001
Tracheal intubation	1 (0.2)	5 (4.8)	<0.001
Renal replacement therapy	0 (0.0)	5 (4.8)	<0.001
Local complications, n (%)
Local drainage	3 (0.7)	15 (14.3)	<0.001
Peripancreatic liquid accumulation	44 (10.4)	45 (42.9)	<0.001
Pseudocysts	6 (1.4)	24 (22.9)	<0.001

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