Fluid sequestration is a useful parameter in the early identification of severe disease of acute pancreatitis

• Published in: Journal of gastroenterology 2019-04, Vol.54 (4), p.359-366
• Main Authors: Takeda, Tsuyoshi, Nakai, Yousuke, Mizuno, Suguru, Suzuki, Tatsunori, Sato, Tatsuya, Hakuta, Ryunosuke, Ishigaki, Kazunaga, Saito, Kei, Saito, Tomotaka, Watanabe, Takeo, Takahara, Naminatsu, Mouri, Dai, Kogure, Hirofumi, Ito, Yukiko, Hirano, Kenji, Tada, Minoru, Isayama, Hiroyuki, Koike, Kazuhiko
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Biliary Tract; Colorectal Surgery; Comparative analysis; Computed tomography; Development and progression; Disease Progression; Female; Fluid Therapy; Gastroenterology; Hepatology; Humans; Inflammation; Intensive care; Intensive Care Units - statistics & numerical data; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Multivariate analysis; Original Article—Liver; Pancreas; Pancreatitis; Pancreatitis - diagnosis; Pancreatitis - physiopathology; Prognosis; Retrospective Studies; Risk Factors; Severity of Illness Index; Surgical Oncology; Systemic inflammatory response syndrome; Young Adult
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-018-1531-6

Background Early identification of severe disease of acute pancreatitis (AP) is of critical importance to improve the prognosis. Fluid sequestration (FS), calculated from administrated fluid and fluid output, is a simple prognostic parameter. We examined its utility in the early phase of AP. Methods We retrospectively investigated AP patients between January 2009 and April 2017. We compared FS in the first 24 h (FS24) with FS in the first 48 h (FS48) and administrated fluid volume within the first 24 h (FV24). Diagnostic yield for predicting intensive care unit (ICU) admission and persistent organ failure (POF) was assessed using receiver operating characteristic curves. We also evaluated risk factors for developing severe disease of AP. Results A total of 400 AP patients were included in the analysis (median age 64 years; male 60%). According to the Japanese severity criteria, 158 patients (40%) were diagnosed as severe disease. The rates of mortality, ICU admission and POF were 0.8%, 4.5% and 7.3%, respectively. FS24 showed a similar predictive accuracy in comparison with FS48 and was superior to FV24 in predicting ICU admission and POF. FS24 ≥ 1.6 L, male sex, presence of systemic inflammatory response syndrome and computed tomography severity index ≥ 3 on admission were independent risk factors for disease progression in AP in the multivariate analysis. Conclusions FS24 was a simple and easily calculated parameter with high predictive accuracy for discriminating patients who needed intensive care. Patients with FS24 ≥ 1.6 L had an increased risk of developing severe disease.