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Meta-Analysis
. 2023 Mar 22;27(1):122.
doi: 10.1186/s13054-023-04401-0.

Comparison of clinical outcomes between aggressive and non-aggressive intravenous hydration for acute pancreatitis: a systematic review and meta-analysis

Xiu-Wei Li  1   2 , Chien-Ho Wang  2   3 , Jhih-Wei Dai  2   4 , Shu-Han Tsao  2   5 , Po-Hsi Wang  6 , Cheng-Chen Tai  7 , Rong-Nan Chien  1   2   8 , Shih-Chieh Shao  9   10   11 , Edward Chia-Cheng Lai  12
Affiliations
Meta-Analysis

Comparison of clinical outcomes between aggressive and non-aggressive intravenous hydration for acute pancreatitis: a systematic review and meta-analysis

Xiu-Wei Li et al. Crit Care. .

Abstract

Background: Current practice guidelines for optimal infusion rates during early intravenous hydration in patients with acute pancreatitis (AP) remain inconsistent. This systematic review and meta-analysis aimed to compare treatment outcomes between aggressive and non-aggressive intravenous hydration in severe and non-severe AP.

Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched PubMed, Embase and Cochrane Library for randomized controlled trials (RCTs) on November 23, 2022, and hand-searched the reference lists of included RCTs, relevant review articles and clinical guidelines. We included RCTs that compared clinical outcomes from aggressive and non-aggressive intravenous hydration in AP. Meta-analysis was performed using a random-effects model for participants with severe AP and non-severe AP. Our primary outcome was all-cause mortality, and several secondary outcomes included fluid-related complications, clinical improvement and APACHE II scores within 48 h.

Results: We included a total of 9 RCTs with 953 participants. The meta-analysis indicated that, compared to non-aggressive intravenous hydration, aggressive intravenous hydration significantly increased mortality risk in severe AP (pooled RR: 2.45, 95% CI: 1.37, 4.40), while the result in non-severe AP was inconclusive (pooled RR: 2.26, 95% CI: 0.54, 9.44). However, aggressive intravenous hydration significantly increased fluid-related complication risk in both severe (pooled RR: 2.22, 95% CI 1.36, 3.63) and non-severe AP (pooled RR: 3.25, 95% CI: 1.53, 6.93). The meta-analysis indicated worse APACHE II scores (pooled mean difference: 3.31, 95% CI: 1.79, 4.84) in severe AP, and no increased likelihood of clinical improvement (pooled RR:1.20, 95% CI: 0.63, 2.29) in non-severe AP. Sensitivity analyses including only RCTs with goal-directed fluid therapy after initial fluid resuscitation therapy yielded consistent results.

Conclusions: Aggressive intravenous hydration increased the mortality risk in severe AP, and fluid-related complication risk in both severe and non-severe AP. More conservative intravenous fluid resuscitation protocols for AP are suggested.

Keywords: Acute pancreatitis; Aggressive intravenous hydration; Meta-analysis; Mortality; Systematic review.

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Conflict of interest statement

There are no possible competing interests related to this work.

Figures

Fig. 1
Fig. 1
Mortality risk, comparing aggressive (intervention) and non-aggressive (control) hydration protocols for acute pancreatitis
Fig. 2
Fig. 2
Fluid-related complication risk, comparing aggressive (intervention) and non-aggressive (control) hydration protocols for acute pancreatitis
Fig. 3
Fig. 3
a Clinical improvement, comparing aggressive (intervention) and non-aggressive (control) hydration protocols for acute pancreatitis b APACHE II score changes within 48 h, comparing aggressive (intervention) and non-aggressive (control) hydration protocols for acute pancreatitis
See this image and copyright information in PMC

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