Intensive vs. moderate fluid resuscitation in acute pancreatitis: A systematic review and meta-analysis

IF 2 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia Pub Date : 2026-08-01 Epub Date: 2026-03-10 DOI:10.1016/j.gastrohep.2026.502715

Naomi Salcedo-Campos, Jose Caballero-Alvarado, Victor Lau-Torres, Carlos Zavaleta-Corvera

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Abstract

Objective

Intravenous fluid resuscitation is central to the early management of acute pancreatitis (AP), but the optimal intensity remains uncertain. This systematic review and meta-analysis compared intensive or aggressive vs. moderate fluid resuscitation in adults with AP.

Patients and methods

This systematic review and meta-analysis followed PRISMA 2020 and was registered in PROSPERO (CRD42024626152). PubMed, Scopus, Web of Science, and Embase were searched from inception to February 15, 2024 for Randomized Controlled Trials (RCT) enrolling adults with acute pancreatitis and comparing intensive/aggressive vs. moderate fluid resuscitation. The primary outcome was in-hospital mortality; secondary outcomes were length of hospital stay, persistence of systemic inflammatory response syndrome (SIRS), fluid-overload complications, and early clinical improvement (≤36 h). Risk of bias was assessed with RoB 2.0. Pooled relative risks (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models according to heterogeneity (I²). Analyses were performed in RevMan 5.4.1.

Results

Seven RCTs were included. IFR was associated with higher mortality than MFR (RR 2.60; 95% CI 1.48–4.57; I² = 0%). IFR did not reduce LOS (MD 1.21 days; 95% CI 0.72–1.69; I² = 65%) or SIRS persistence (RR 0.87; 95% CI 0.50–1.52; I² = 26%). Fluid-overload complications were more frequent with IFR (RR 3.34; 95% CI 1.60–6.98; I² = 0%). Early clinical improvement did not differ (RR 1.20; 95% CI 0.63–2.29; I² = 72%). Risk of bias was generally low.

Conclusions

Across randomized evidence, intensive hydration offers no clinical benefit over moderate regimens and is associated with higher mortality and greater risk of fluid overload. Findings support moderate, goal-directed, individualized fluid therapy in acute pancreatitis and highlight the need for large multicenter RCTs to refine fluid targets and monitoring endpoints.

查看原文本刊更多论文

急性胰腺炎强化与中度液体复苏：系统回顾和荟萃分析

目的：静脉液体复苏是急性胰腺炎（AP）早期治疗的核心，但最佳强度仍不确定。该系统评价和荟萃分析比较了成人ap患者的强化或积极与中度液体复苏。患者和方法：该系统评价和荟萃分析遵循PRISMA 2020，并在PROSPERO注册（CRD42024626152）。检索PubMed、Scopus、Web of Science和Embase，检索从成立到2024年2月15日纳入急性胰腺炎成人的随机对照试验（RCT），并比较强化/积极与中度液体复苏。主要结局是住院死亡率；次要结局是住院时间、系统性炎症反应综合征（SIRS）持续时间、体液超载并发症和早期临床改善（≤36小时）。偏倚风险采用rob2.0进行评估。根据异质性（I²），使用固定效应或随机效应模型计算合并相对危险度（RR）和95%置信区间（CI）的平均差异（MD）。在RevMan 5.4.1中进行分析。结果：纳入7项rct。IFR的死亡率高于MFR （RR 2.60; 95% CI 1.48-4.57; I²=0%）。IFR没有降低LOS （MD 1.21天；95% CI 0.72-1.69; I²=65%）或SIRS持续性（RR 0.87; 95% CI 0.50-1.52; I²=26%）。IFR患者的体液超载并发症更为频繁（RR 3.34; 95% CI 1.60-6.98; I²=0%）。早期临床改善无差异（RR 1.20; 95% CI 0.63-2.29; I²=72%）。偏倚风险普遍较低。结论：在随机证据中，强化水合治疗与中等治疗方案相比没有临床益处，并且与更高的死亡率和更大的体液超载风险相关。研究结果支持适度、目标导向、个体化的急性胰腺炎液体治疗，并强调需要大型多中心随机对照试验来完善液体靶点和监测终点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastroenterologia y hepatologia GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

1.50

自引率

10.50%

发文量

147

审稿时长

48 days

期刊介绍： Gastroenterology and Hepatology is the first journal to cover the latest advances in pathology of the gastrointestinal tract, liver, pancreas, and bile ducts, making it an indispensable tool for gastroenterologists, hepatologists, internists and general practitioners.