Gad MM, Simons-Linares CR. Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies. World J Gastroenterol 2020; 26(10): 1098-1106 [PMID: 32206000 DOI: 10.3748/wjg.v26.i10.1098]
Corresponding Author of This Article
C. Roberto Simons-Linares, MD, MSc, Assistant Professor, Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States. robertosimons@outlook.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Mar 14, 2020; 26(10): 1098-1106 Published online Mar 14, 2020. doi: 10.3748/wjg.v26.i10.1098
Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies
Mohamed M Gad, C. Roberto Simons-Linares
Mohamed M Gad, Internal Medicine Department, Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, United States
C. Roberto Simons-Linares, Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Simons-Linares CR has formulated the concept/study idea, study design, review literature, manuscript drafting, writing; Gad MM has review the literature, contributed to metaanalysis design, statistical support, and manuscript drafting.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: This is study followed PRISMA guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: C. Roberto Simons-Linares, MD, MSc, Assistant Professor, Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States. robertosimons@outlook.com
Received: October 4, 2019 Peer-review started: October 4, 2019 First decision: November 4, 2019 Revised: January 12, 2020 Accepted: February 21, 2020 Article in press: February 21, 2020 Published online: March 14, 2020 Processing time: 162 Days and 11.7 Hours
Abstract
BACKGROUND
There is conflincting evidence on the intravenous fluid (IVF) strategy for acute pancreatitis (AP). We perform a metaanalysis of the available evidence.
AIM
To investigate if aggressive IVF therapy in AP patients is beneficial to decrease mortality and improve outcomes.
METHODS
Metaanalysis of available randomized controlled trials and cohort studies comparing aggressive IVF vs non-aggressive IVF resuscitation.
RESULTS
There was no significant difference in mortality between the aggressive (n = 1229) and non-aggressive IVF (n = 1397) patients. Patients receiving aggressive IVF therapy had higher risk for acute kidney injury and acute respiratory distress syndrome. There also was no significant difference in the overall incidence of systemic inflammatory response syndrome, persistent organ failure, pancreatic necrosis when comparing both study groups.
CONCLUSION
Early aggressive IVF therapy did not improve mortality. Moreover, aggressive IVF therapy could potentially increase the risk for acute kidney injury and pulmonary edema leading to respiratory failure and mechanical ventilation. Studies are needed to investigate which subset of AP patients could benefit from aggressive IVF therapy.
Core tip: Early aggressive intravenous fluid therapy did not improve mortality of acute pancreatitis patients and could potentially be harmful. The intravenous fluid therapy strategy in acute pancreatitis patients remains to be elucidated.
