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Journal of Gastroenterology

, Volume 54, Issue 4, pp 359–366 | Cite as

Fluid sequestration is a useful parameter in the early identification of severe disease of acute pancreatitis

  • Tsuyoshi Takeda
  • Yousuke NakaiEmail author
  • Suguru Mizuno
  • Tatsunori Suzuki
  • Tatsuya Sato
  • Ryunosuke Hakuta
  • Kazunaga Ishigaki
  • Kei Saito
  • Tomotaka Saito
  • Takeo Watanabe
  • Naminatsu Takahara
  • Dai Mouri
  • Hirofumi Kogure
  • Yukiko Ito
  • Kenji Hirano
  • Minoru Tada
  • Hiroyuki Isayama
  • Kazuhiko Koike
Original Article—Liver, Pancreas, and Biliary Tract
  • 209 Downloads

Abstract

Background

Early identification of severe disease of acute pancreatitis (AP) is of critical importance to improve the prognosis. Fluid sequestration (FS), calculated from administrated fluid and fluid output, is a simple prognostic parameter. We examined its utility in the early phase of AP.

Methods

We retrospectively investigated AP patients between January 2009 and April 2017. We compared FS in the first 24 h (FS24) with FS in the first 48 h (FS48) and administrated fluid volume within the first 24 h (FV24). Diagnostic yield for predicting intensive care unit (ICU) admission and persistent organ failure (POF) was assessed using receiver operating characteristic curves. We also evaluated risk factors for developing severe disease of AP.

Results

A total of 400 AP patients were included in the analysis (median age 64 years; male 60%). According to the Japanese severity criteria, 158 patients (40%) were diagnosed as severe disease. The rates of mortality, ICU admission and POF were 0.8%, 4.5% and 7.3%, respectively. FS24 showed a similar predictive accuracy in comparison with FS48 and was superior to FV24 in predicting ICU admission and POF. FS24 ≥ 1.6 L, male sex, presence of systemic inflammatory response syndrome and computed tomography severity index ≥ 3 on admission were independent risk factors for disease progression in AP in the multivariate analysis.

Conclusions

FS24 was a simple and easily calculated parameter with high predictive accuracy for discriminating patients who needed intensive care. Patients with FS24 ≥ 1.6 L had an increased risk of developing severe disease.

Keywords

Acute pancreatitis Fluid sequestration Fluid volume Severity prediction Risk factor 

Abbreviations

AP

Acute pancreatitis

CTSI

Computed tomography severity index

FS

Fluid sequestration

FV

Fluid volume

ICU

Intensive care unit

IPN

Infected pancreatic necrosis

POF

Persistent organ failure

SIRS

Systemic inflammatory response syndrome

Notes

Acknowledgements

We have no funds and grants in this study.

Author contributions

TT, SM, and YN: concept and design of the study, analysis and interpretation of data, and drafting of the article. TT, TS (Tatsunori Suzuki), TS (Tatsuya Satou), RH, KI, KS, TS, TW, NT, DM, HK, YI, KH, MT: data collection. HI and KK: critical revision of the article for important intellectual content. All authors: final approval of the article.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Tsuyoshi Takeda
    • 1
  • Yousuke Nakai
    • 1
    Email author
  • Suguru Mizuno
    • 1
  • Tatsunori Suzuki
    • 1
  • Tatsuya Sato
    • 1
  • Ryunosuke Hakuta
    • 1
  • Kazunaga Ishigaki
    • 1
  • Kei Saito
    • 1
  • Tomotaka Saito
    • 1
  • Takeo Watanabe
    • 2
  • Naminatsu Takahara
    • 1
  • Dai Mouri
    • 3
  • Hirofumi Kogure
    • 1
  • Yukiko Ito
    • 4
  • Kenji Hirano
    • 2
  • Minoru Tada
    • 1
  • Hiroyuki Isayama
    • 5
  • Kazuhiko Koike
    • 1
  1. 1.Department of GastroenterologyGraduate School of Medicine, The University of TokyoTokyoJapan
  2. 2.Department of GastroenterologyTokyo Takanawa HospitalTokyoJapan
  3. 3.Department of GastroenterologyJR Tokyo General HospitalTokyoJapan
  4. 4.Department of GastroenterologyJapanese Red Cross Medical CenterTokyoJapan
  5. 5.Department of GastroenterologyGraduate School of Medicine, Juntendo UniversityTokyoJapan

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