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Vol. 2, No. 2, 2002
Issue release date: 2002
Pancreatology 2002;2:104–107
(DOI:10.1159/000055899)

Can Fluid Resuscitation Prevent Pancreatic Necrosis in Severe Acute Pancreatitis?

Brown A. · Baillargeon J.D. · Hughes M.D. · Banks P.A.
aCenter for Pancreatic Disease, Brigham and Women’s Hospital, Harvard Medical School, and bDepartment of Biostatistics, Harvard School of Public Health, Boston, Mass., USA

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Abstract

Background/Aims: In previous studies, we have demonstrated that hemoconcentration was an early marker for necrotizing pancreatitis.The aim of the present study was to determine whether fluid resuscitation could prevent pancreatic necrosis among patients with hemoconcentration at the time of admission. Methods: Data was pooled from the prior two studies of all patients with necrotizing pancreatitis and interstitial pancreatitis with a hematocrit of ≧44 on admission. Hematocrit values in necrotizing pancreatitis and interstitial pancreatitis were compared at admission and at 24 h. Statistical analyses were performed using the Wilcoxon rank-sum test. Results: A total of 39 patients satisfied our inclusion criteria, 28 with necrotizing pancreatitis and 11 with interstitial pancreatitis. Patients with necrotizing pancreatitis presented earlier than patients with interstitial pancreatitis (median 18 vs. 38 h, respectively) (p = 0.005). There was no significant difference between the intergroup median hematocrits on admission and at 24 h. All patients with hematocrits that failed to decrease at 24 h developed necrotizing pancreatitis (12/28 with necrotizing pancreatitis vs. 0/11 with interstitial pancreatitis) (p = 0.009). There was no significant difference at 24 h in rehydration among the three groups: 4.0 liters among the 12 patients with necrotizing pancreatitis whose hematocrits increased and 4.5 liters among the 16 whose hematocrits decreased at 24 h, and 4.1 liters among the 11 patients with interstitial pancreatitis (p = 0.81). Conclusion: Patients who presented early were more likely to have necrotizing pancreatitis than interstitial pancreatitis. While fluid resuscitation was not shown to prevent pancreatic necrosis, all patients with inadequate fluid resuscitation as evidenced by persistence of hemoconcentration at 24 h developed necrotizing pancreatitis.



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References

  1. Baillargeon J-D, Orav J, Ramagopal V, Tenner SM, Banks PA: Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol 1998;93:2130–2134.
  2. Brown A, Orav J, Banks PA: Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas 2000;20:367–372.
  3. Choi B: Slopes of a receiver operating characteristic curve and likelihood ratios for a diagnostic test. Am J Epidemiol 1998;148:1127–1131.
  4. Pezzilli R, Billi P, Morselli-Labate AM: Severity of acute pancreatitis: Relationship with etiology, sex and age. Hepatogasteroenterology 1998;45:1859–1864.
  5. Lankisch PG, Mahlke R, Blum T, Bruns A, Bruns D, Maisonneuve P, Lowenfels AB: Hemoconcentration: An early marker or severe and/or necrotizing pancreatitis? A critical appraisal. Am J Gastroenterol 2001;96:2081–2085.

    External Resources

  6. Hotz HG, Schmidt J, Ryschich EW, Foitzik T, Buhr HJ, Warshaw AW, Herfarth C, Klar E: Isovolemic hemodilution with dextran prevents contrast medium induced impairment of pancreatic micro-circulation in necrotizing pancreatitis of the rat. Am J Surg 1995;169:161–166.

    External Resources

  7. Schmidt J, Rattner DW, Lewandrowski K, Compton C, Mandavilli U, Knoefel W, Warshaw A: A better model of acute pancreatitis for evaluating therapy. Ann Surg 1991;215:45–56.
  8. Leese T, Shaw D, Holliday M: Prognostic markers in acute pancreatitis: Can pancreatitis necrosis be predicted? Ann R Coll Surg Engl 1998;70:227–232.
  9. Sanfey H, Cameron JL: Increased capillary permeability: An early lesion in acute pancreatitis. Surgery 1984;96:485–491.

    External Resources

  10. Bassi D, Kollias N, Fernandez-del Castillio C, Foitzik T, Warshaw W, Rattner DW: Impairment of pancreatic microcirculation correlates with the severity of acute experimental pancreatitis. J Am Coll Surg 1994;179:257–263.
  11. Kerner T, Vollmar B, Menger MD, Waldner H, Messmer K: Determinants of pancreatic microcirculation in rats. J Surg Res 1996;62:165–171.
  12. Klar E, Foitzik T, Buhr H, Messmer K, Herfarth C: Isovolemic hemodilution with Dextran 60 as treatment of pancreatic ischemia in acute pancreatitis. Ann Surg 1993;217:369–374.
  13. Klar E, Schratt W, Foitzik T, Buhr H, Herfarth C, Messmer K: Impact of microcirculatory flow pattern on the development of acute edematous and necrotizing pancreatitis in rabbit pancreas. Dig Dis Sci 1994;39:2639–2644.
  14. Forgacs B, Eibl G, Faulhaber J, Kahrau S, Buhr H, Foitzik T: Effect of fluid resuscitation with and without endothelin A receptor blockade on hemoconcentration and organ function in experimental pancreatitis. Eur Surg Res 2000;32:162–168.


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