The impact of early fluid management on C-reactive protein levels and the severity and progression in the patients with acute pancreatitis

Zhao Zhen; Yan Luvcheng; Wang Guoxing

doi:10.3969/j.issn.1002-1949.2024.10.008

Abstract：Objective To investigate the impact of early fluid management on C-reactive protein(CRP)and the severity and progression in the patients with acute pancreatitis(AP).Methods We retrospectively analyzed 214 patients with various types of AP admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from January 2016 to October 2022.The patients'general information,CRP,fluid volume within 0-24 h and 24-48 h of admission were recorded.According to the average fluid replacement rate,the patients were divided into the low fluid replacement rate group and the high fluid replacement rate group.The main outcome measures were average length of hospital stay,the progression of AP after 1 week,new onset heart dysfunction,new onset kidney dysfunction and survival rate.The study was developed to analyze the impact of different fluid replacement rates on CRP and the severity and progression during early period(0-24 h and 24-48 h).Results The average fluid replacement rate of AP patients was 29.6 mL/(kg·24 h).During the first 24 h of hospitalization and the subsequent 24-48 h,the proportion of females was significantly higher than that of males in the low fluid replacement rate group[＜29.6 mL/(kg·24 h)](P＜0.05).During the first 24 h of hospitalization,the low fluid replacement rate group has higher CRP levels on the third,fifth and seventh day compared to the high fluid replacement rate group(Z=-2.659,-2.541,-2.191,all P＜0.05).Similarly,during the subsequent 24-48 h of hospitalization,the low fluid replacement rate group has higher CRP levels on the first,third and fifth day compared to the high fluid replacement rate group(Z=-2.121,-2.288,-2.208,all P＜0.05).The average time of hospitalization in the high and low fluid replacement rate group was(8.60±4.17)d and(9.01±4.21)d,there was no statistical significance between the two groups.1 week after admission,the severity of AP in the patients was re-evaluated,and a total of 15 patients appeared the aggravated symptoms including six people in the high fluid replacement rate group and nine people in the low fluid replacement rate group with a relative risk factor of 1.081(0.406-2.874).8 patients had new onset heart dysfunction including three in the low fluid replacement rate group and five in the high fluid replacement rate group.The relative risk factor for new onset heart dysfunction in the high fluid replacement rate group was 1.022(0.969-1.078).10 patients had new onset renal dysfunction,including 4 in the low fluid replacement rate group and 6 in the high fluid replacement rate group.The relative risk factor for renal dysfunction in the low fluid replacement rate group was 1.023(0.963-1.086).Conclusions In the early fluid management of AP,the infusion rate for female patients is lower than that for male patients.Relative aggressive fluid management helps improve CRP in the patients with AP.The low fluid replacement rate group is more likely to experience further worsening of AP and renal dysfunction,while the high fluid replacement rate group is more likely to experience heart dysfunction.