Tao Jin1, Kun Jiang2, Lihui Deng2, Jia Guo2, Yuwan Wu2, Zhengyan Wang2, Na Shi2, Xiaoxin Zhang2, Ziqi Lin2, Varsha Asrani3, Peter Jones4, Anubhav Mittal5, Anthony Phillips6, Robert Sutton7, Wei Huang8, Xiaonan Yang9, Qing Xia10, John A Windsor11. 1. Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China; Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. 2. Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China. 3. Department of Nutrition Service, Auckland City Hospital, Auckland, New Zealand. 4. Emergency Department, Auckland City Hospital, Auckland, New Zealand. 5. Department of Surgery, Royal North Shore Hospital, Sydney, Australia. 6. Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand. 7. Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. 8. Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China; Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. Electronic address: dr_wei_huang@163.com. 9. Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China. Electronic address: xiaonanyang_wch@163.com. 10. Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China. Electronic address: xiaqing@medmail.com.cn. 11. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Abstract
BACKGROUND: Intravenous (IV) fluid resuscitation remains the cornerstone for early management of acute pancreatitis (AP), but many questions remain unanswered, including how to determine whether patients will benefit from additional fluids. The aim was to investigate the utility of serum biomarkers of responsiveness IV fluid resuscitation in patients with AP and systemic inflammatory response syndrome (SIRS). METHODS: Eligible adult patients had abdominal pain for <36 h and ≥2 SIRS criteria. Mean arterial pressure (>65 mmHg) and urine output (>0.5 ml/kg/h) were used to assess responsiveness at 2 and 6-8 h after initiation of IV fluids. Comparison was made between responsive and refractory patients at time points for fluid volume, biomarkers and outcomes. RESULTS: At 2 h 19 patients responded to fluids (Group 1) while 4 were refractory (Group 2); at 6-8 h 14 responded (Group 3) and 9 were refractory (Group 4). No demographic differences between patient groups, but Group 4 had worse prognostic features than Group 3. Refractory patients received significantly more fluid (Group 4 mean 7082 ml vs. Group 3 5022 mL, P < 0.001) in first 24 h and had worse outcome. No significant differences in biomarkers between the groups. CONCLUSIONS: The serum biomarkers did not discriminate between fluid responsive and refractory patients. Refractory patients at 6-8 h had more severe disease on admission, did not benefit from additional fluids and had a worse outcome. New approaches to guide fluid resuscitation in patients with AP are required.
BACKGROUND: Intravenous (IV) fluid resuscitation remains the cornerstone for early management of acute pancreatitis (AP), but many questions remain unanswered, including how to determine whether patients will benefit from additional fluids. The aim was to investigate the utility of serum biomarkers of responsiveness IV fluid resuscitation in patients with AP and systemic inflammatory response syndrome (SIRS). METHODS: Eligible adult patients had abdominal pain for <36 h and ≥2 SIRS criteria. Mean arterial pressure (>65 mmHg) and urine output (>0.5 ml/kg/h) were used to assess responsiveness at 2 and 6-8 h after initiation of IV fluids. Comparison was made between responsive and refractory patients at time points for fluid volume, biomarkers and outcomes. RESULTS: At 2 h 19 patients responded to fluids (Group 1) while 4 were refractory (Group 2); at 6-8 h 14 responded (Group 3) and 9 were refractory (Group 4). No demographic differences between patient groups, but Group 4 had worse prognostic features than Group 3. Refractory patients received significantly more fluid (Group 4 mean 7082 ml vs. Group 3 5022 mL, P < 0.001) in first 24 h and had worse outcome. No significant differences in biomarkers between the groups. CONCLUSIONS: The serum biomarkers did not discriminate between fluid responsive and refractory patients. Refractory patients at 6-8 h had more severe disease on admission, did not benefit from additional fluids and had a worse outcome. New approaches to guide fluid resuscitation in patients with AP are required.
Authors: Na Shi; Tingting Liu; Daniel de la Iglesia-Garcia; Lihui Deng; Tao Jin; Lan Lan; Ping Zhu; Weiming Hu; Zongguang Zhou; Vikesh Singh; J Enrique Dominguez-Munoz; John Windsor; Wei Huang; Qing Xia; Robert Sutton Journal: Gut Date: 2019-02-11 Impact factor: 23.059
Authors: Lan Li; Tao Jin; Si Wen; Na Shi; Ruwen Zhang; Ping Zhu; Ziqi Lin; Kun Jiang; Jia Guo; Tingting Liu; Anthony Philips; Lihui Deng; Xiaonan Yang; Vikesh K Singh; Robert Sutton; John A Windsor; Wei Huang; Qing Xia Journal: Dig Dis Sci Date: 2020-01-07 Impact factor: 3.199
Authors: Tao Jin; Lan Li; Lihui Deng; Si Wen; Ruwen Zhang; Na Shi; Ping Zhu; Lan Lan; Ziqi Lin; Kun Jiang; Jia Guo; Tingting Liu; Anthony Philips; Xiaonan Yang; Vikesh K Singh; Robert Sutton; John A Windsor; Wei Huang; Qing Xia Journal: JGH Open Date: 2020-03-13