Prevalence of Fluid Overload in a Cohort of Patients with Acute Pancreatitis: Results from a Retrospective Tertiary Single-center Study

Objectives: Aggressive fluid expansion has been an undisputed aspect about navigating the early stages of acute pancreatitis. Evidence produced by the WATERFALL trial supports a more conservative approach to fluid resuscitation as patients face higher odds of fluid overload while experiencing no benefit of their underlying condition. This retrospective monocentric observational study seeks to identify fluid-related complications in patients with acute pancreatitis of any grade of severity. Methods: One-hundred-twenty-nine patients with acute pancreatitis including moderately severe and severe courses were divided into groups based on their cumulative fluid administration within the first 24 hours (restrictive: <3 L; moderate: 3–6 L; aggressive: >6 L). Vital signs and laboratory values were reported at defined time points. Results: Most patients were allocated to the group of moderate fluid resuscitation. At baseline, patients did not differ in systemic disease severity indicated by critical illness scores. A higher proportion of patients with moderately severe or severe pancreatitis associated with an acute peripancreatic fluid collection had previously been administered >6 L fluids. C-reactive protein levels were significantly higher in patients with >6 L while albumin levels were decreased. Patients receiving >6 L fluids were more likely to show radiological features of pulmonary fluid overload and be transferred to intensive care unit. In addition, oxygenation markedly deteriorated in aggressively hydrated patients versus restrictive and moderate fluid regimes. Conclusion: The extent of fluid resuscitation was found to be strongly associated with the prevalence of clinical and radiological signs of pulmonary fluid overload. Furthermore, moderately severe and severe courses of pancreatitis were more frequently observed in excessively hydrated patients.