Aggressive vs conservative hydration for acute pancreatitis management

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Created On: 24/02/2022

This meta-analysis was carried out to determine if aggressive hydration strategies are more beneficial in comparison with conservative hydration strategies for the management of acute pancreatitis.

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Key take away

For the early phase of acute pancreatitis management in adult patients, conservative hydration strategies seem to be better than aggressive hydration strategies.

Background

This meta-analysis was carried out to determine if aggressive hydration strategies are more beneficial in comparison with conservative hydration strategies for the management of acute pancreatitis.

Method

Databases like Cochrane Library, Embase, and PubMed were explored to find out eligible trials that comparatively evaluated two hydration strategies. A total of 8 observational trials and 5 randomized controlled trials involving 3127 participants were detected. In-hospital mortality was the major endpoint ascertained while the occurrence of adverse events (like pancreatic necrosis and kidney failure) within 24 hours of therapy were the secondary endpoints ascertained.

Result

Notably, 5 subjects suffering from severe pancreatitis demonstrated a significant difference of in-hospital mortality (Odds Ratio [OR] 1.75) in the aggressive hydration group, that were less susceptible to age and study type. Subjects having severe pancreatitis were likely to suffer from kidney failure (OR 2.58), respiratory failure (OR 5.08), persistent systemic inflammatory response syndrome (SIRS, OR 2.83) with a major difference.

In the aggressive hydration group, a longer hospital stay was reported in people having severe pancreatitis (weighted mean difference 7.61). A greater occurrence of pancreatic necrosis (OR 2.34) was highly susceptible to observational studies, mild pancreatitis, and old people.

Conclusion

In comparison with conservative hydration strategy, aggressive hydration strategy elevates in-hospital mortality and the occurrence of kidney failure, pancreatic necrosis with relatively strong evidences.