Published online Mar 14, 2020. doi: 10.3748/wjg.v26.i10.1098
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
There is conflincting evidence on the intravenous fluid (IVF) strategy for acute pancreatitis (AP). We perform a metaanalysis of the available evidence.
To investigate if aggressive IVF therapy in AP patients is beneficial to decrease mortality and improve outcomes.
Metaanalysis of available randomized controlled trials and cohort studies comparing aggressive IVF vs non-aggressive IVF resuscitation.
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.
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.