Background: The WATERFALL randomized controlled trial (RCT) demonstrated that aggressive fluid resuscitation is associated with fluid overload without improving clinical outcomes compared to moderate fluid resuscitation. However, these fluid resuscitation regimens were administered up to 8 hours after disease diagnosis, and the effect of fluid resuscitation administered before recruitment in the emergency room (ER) was not analyzed. We aimed to assess the effect of ER fluid resuscitation on clinical and safety parameters among patients with acute pancreatitis who participated in the WATERFALL trial.
Methods: Posthoc analysis of the WATERFALL RCT database. Patients with data on Fluids administered Prior to Randomization (FPR) were included. A high FPR was defined as patients receiving >median FPR volume. Uni- and multivariate analysis (binary logistic regression with the following variables: age, center, sex, baseline BISAP≥3, alcoholic etiology, aggressive versus moderate treatment arm, and high FPR) were performed.
Results: We analyzed 186 patients, 93 in the aggressive and 93 in the moderate fluid resuscitation arm of treatment, for whom data on FPR were available. The median and interquartile range of FPR was 700 (500-1000) ml. A volume of FPR>700mL (92 patients, 49.5%) was not associated with increased incidence of moderate to severe acute pancreatitis, nor with differences in other clinical or safety outcomes in univariate analysis (Table 1). Furthermore, multivariate analysis showed no association between the administration of high FPR and clinical or safety outcomes (Table 1).
Conclusions: ER administration of fluid resuscitation seems not associated with changes in clinical or safety endpoints in acute pancreatitis.

Raj Tandel

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