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CHANGES IN FLUID DISTRIBUTION AND HAEMODYNAMICS IN THE EARLY PHASE OF ACUTE PANCREATITIS

Morten Laksáfoss Lauritsen 1, Mikkel Parsberg Werge 1, Mirjana Cihoric 1, Henrik Løvendahl Jørgensen 1, Nicolai Bang Foss 1, John Gásdal Karstensen 1, Lise Lotte Gluud 2, Srdan Novovic 1

Affiliations

1 Hvidovre University Hospital, Hvidovre, Denmark

2 University Hospital Hvidovre, Hvidovre, Denmark

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Abstract

Introduction

In the early phase of acute pancreatitis (AP), fluid resuscitation plays a crucial role. Changes in fluid distribution, increased capillary permeability, minimized intravascular volume, and loss of vascular resistance may lead to cardio-vascular and renal failure. On the other hand, overhydration is associated with cardiac decompensation and respiratory failure. Previously, intensive fluid therapy with large volumes of crystalloids was recommended without addressing individual needs for fluid therapy.
We used measurements of physiological parameters focusing on cardiac function and changes in body composition, to study the association between fluid therapy and physiological response, in the patient with AP.

Aims & Methods

This study aimed to assess fluid distribution in relation to fluid therapy, inflammation, and cardiac- and renal function in the early phase of AP.
This was a single-centre, prospective observational cohort study. On baseline, day 1, 2, 10 and 90 following were assessed: preload dependency (passive leg raise manoeuvre and defined as a >10% increase in stroke volume), hemodynamic parameters (stroke volume, cardiac output measured by non-invasive monitoring (Non-invasive LiDCOrapidTM; LiDCO, London, UK)), bioimpedance variables (weight, extracellular water (ECW), total body water(TBW) by seca mBCA 525, Germany). White blood count (WBC), C-reactive protein (CRP), and creatinine were measured and Modified Marshall score was calculated on each time point. Data are presented as medians with interquartil range (IQR). [jK1] Pearson correlation coefficient was used to assess the relationship between changes in weight and haemodynamic and bioimpedance parameters.

Results

Eighty-eight patients with first-time AP were included. Median age was 58 years, 46 were females. Gallstones were the predominant etiology (55%). At baseline, 35 patients (40%) were preload dependent. However, the median increase in weight during the first 10 days of admission was 2.65 kg (IQR: 0.9;4.73). Across time points, patients in the fourth upper quartile of weight increase had significantly higher volume of ECW than patients in the 1-3. quartile (p=0.02). No differences were observed for stroke volume, nor cardiac output. CRP was significantly higher in patients in the fourth upper quartile of weight increase than in patients in quartile 1-3. No difference was found for WBC and creatinine.
We found a significant correlation between increasing bodyweight and extracellular water volume, R=0.383, (p<0.0001), but not between increasing bodyweight and stroke volume R=-0.016 (p=0.783) or cardiac output, R=0.015 (p=0.796). Also, a significant correlation was found between creatinine and increasing weight, R=0.229 (p<0.0001). Modified Marshall score was significantly correlated to increasing body weight, R=0.159 (p=0.006).

Conclusion

The assessment of hydration status in AP requires an in-depth knowledge of body fluid homeostasis. Our data provide physiological rationale for emerging evidence regarding more restricitive fluid resuscitation. Personalized- and goal directed therapy may be a promising novel way in the transition from necessary fluid resuscitation to harmful fluid volume accumulation in the early phase of AP.

References

The Interplay between Inflammation, Coagulation and Endothelial Injury in the Early Phase of Acute Pancreatitis: Clinical Implications.
Dumnicka P, Maduzia D, Ceranowicz P, Olszanecki R, Drożdż R, Kuśnierz-Cabala B.
Int J Mol Sci. 2017 Feb 8;18(2):354. doi: 10.3390/ijms18020354.
Tenner S, Baillie J, DeWitt J, Vege SS;
American college of Gastroenterology guideline: management of acute pancreatitits
Am J Gastroenterol 2013; 108: 1400-16.27.
Working group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidencebased guidelines for the management of acute pancreatitis
Pancreatology 2013; 13:Suppl 2:e1-e15
Disturbances of the microcirculation in acute pancreatitis.
Cuthbertson CM, Christophi C.
Br J Surg. 2006 May;93(5):518-30. doi: 10.1002/bjs.5316.
Fluid Resuscitation in Acute Pancreatitis - Going over the WATERFALL.
Gardner TB
N Engl J Med. 2022 Sep 15;387(11):1038-1039. doi: 10.1056/NEJMe2209132.

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

Acute pancreatitis (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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