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Review
. 2024 Dec 13;8(12):e70073.
doi: 10.1002/jgh3.70073. eCollection 2024 Dec.

Aggressive Versus Moderate Fluid Replacement for Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Muhammad Ehsan  1   2 , Aamna Badar Ahmad  1 , Haseeba Javed  1 , Afra Zahid  1 , Hafiz Sheheryar Aamir  1 , Huzaifa Ahmad Cheema  1 , Muhammad Ayyan  1 , Biah Mustafa  1 , Abia Shahid  1 , Muhammad Abdullah Ilyas  1 , Kamal Kandel  3 , Rehmat Ullah Awan  4 , Sana Iqbal  5
Affiliations
Review

Aggressive Versus Moderate Fluid Replacement for Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Muhammad Ehsan et al. JGH Open. .

Abstract

Background: A conservative strategy is the primary modality of treatment for acute pancreatitis of which fluid replacement is an important component. Since the results regarding early aggressive versus moderate fluid replenishment for acute pancreatitis are inconsistent, we sought to compare outcomes between the two resuscitation strategies in our meta-analysis.

Methods: We searched MEDLINE (PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov for all available randomized controlled trials (RCTs) assessing outcomes for patients treated with aggressive fluid replacement compared to moderate fluid replacement. Our primary outcome was all-cause mortality.

Results: Our meta-analysis included 6 RCTs involving a total of 632 patients. Our results showed that aggressive fluid resuscitation increased the risk of all-cause mortality as compared to moderate fluid replacement (RR 2.40, CI: 1.38-4.19). For all of our secondary outcomes which included the development of organ failure, severe pancreatitis, pancreatic necrosis, clinical improvement, development of SIRS, persistent SIRS, and length of hospital stay, the results indicate that there was no significant difference between the two groups.

Conclusions: Aggressive fluid resuscitation is associated with higher mortality as compared to moderate fluid replacement in patients with acute pancreatitis. RCTs with larger sample sizes are needed to provide greater statistical power and establish more definitive conclusions.

Keywords: acute pancreatitis; fluid replacement; fluid resuscitation; meta‐analysis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA 2020 flow chart of included and excluded trials. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses.
FIGURE 2
FIGURE 2
Comparison of mortality between patients receiving aggressive fluid or moderate fluid replacement for acute pancreatitis; IV, inverse variance.
FIGURE 3
FIGURE 3
Forest plot for secondary outcomes: (A) Development of organ failure; (B) Incidence of severe pancreatitis; (C) Development of pancreatic necrosis; (D) Clinical improvement; (E) Development of SIRS; (F) Development of persistent SIRS; (G) Length of hospital stay.
See this image and copyright information in PMC

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