Hemoconcentration is associated with early faster fluid rate and increased risk of persistent organ failure in acute pancreatitis patients
Tao Jin,
Lan Li,
Lihui Deng,
Si Wen,
Ruwen Zhang,
Na Shi,
Ping Zhu,
Lan Lan,
Ziqi Lin,
Kun Jiang,
Jia Guo,
Tingting Liu,
Anthony Philips,
Xiaonan Yang,
Vikesh K Singh,
Robert Sutton,
John A Windsor,
Wei Huang,
Qing Xia
Affiliations
Tao Jin
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Lan Li
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Lihui Deng
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Si Wen
Department of Endocrinology and Metabolism Yichang Hospital of Traditional Chinese Medicine Yichang China
Ruwen Zhang
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Na Shi
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Ping Zhu
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Lan Lan
West China Biomedical Big Data Centre, West China Hospital Sichuan University Chengdu China
Ziqi Lin
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Kun Jiang
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Jia Guo
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Tingting Liu
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Anthony Philips
Applied Surgery and Metabolism Laboratory, School of Biological Sciences University of Auckland Auckland New Zealand
Xiaonan Yang
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Vikesh K Singh
Pancreatitis Centre, Division of Gastroenterology Johns Hopkins Medical Institutions Baltimore USA
Robert Sutton
Liverpool Pancreatitis Research Group, Royal Liverpool University Hospital and Institute of Translational Medicine University of Liverpool Liverpool UK
John A Windsor
Surgical and Translational Research Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
Wei Huang
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Qing Xia
Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China‐Liverpool Biomedical Research Centre, West China Hospital Sichuan University Chengdu China
Abstract Background Controversies existed surrounding the use of hematocrit to guide early fluid therapy in acute pancreatitis (AP). The association between hematocrit, early fluid therapy, and clinical outcomes in ward AP patients needs to be investigated. Methods Data from prospectively maintained AP database and retrospectively collected details of fluid therapy were analyzed. Patients were stratified into three groups: Group 1, hematocrit 44% at 24 h; Group 3: hematocrit >44% on admission and decreased thereafter during first 24 h. “Early” means first 24 h after admission. Baseline characteristics, early fluid rates, and clinical outcomes of the three groups were compared. Results Among the 628 patients, Group 3 had a higher hematocrit level, greater baseline predicted severity, faster fluid rate, and more fluid volume in the first 24 h compared with Group 1 or 2. Group 3 had an increased risk for persistent organ failure (POF; odds ratio 2, 95% confidence interval [1.1–3.8], P = 0.03) compared with Group 1 after adjusting for difference in baseline clinical severity scores, there was no difference between Group 2 and Group 3 or Group 1. Multivariate regression analyses revealed that hemoconcentration and early faster fluid rate were risk factors for POF and mortality (both P < 0.05). Conclusions Hemoconcentration is associated with faster fluid rate and POF in ward AP patients. Randomized trials comparing standardized early fast and slow fluid management is warranted.
