Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Pancreatology 2011;11:351–361 DOI: 10.1159/000328965 Early Crystalloid Fluid Volume Management in Acute Pancreatitis: Association with Mortality and Organ Failure Kazuaki Kuwabara   a Shinya Matsuda   b Kiyohide Fushimi   c Koichi B. Ishikawa   d Hiromasa Horiguchi   e Kenji Fujimori   f a  Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, b  Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, c  Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, d  Statistics and Cancer Control Division, National Cancer Center, and e  Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Tokyo, and f  Division of Medical Management, Hokkaido University, Sapporo, Japan not requiring ventilation. A high FV48 increased mortality and a high FVR decreased mortality in patients with severe AP. A high FV48 required ventilation in patients with severe AP, which was independently associated with mortality. Conclusion: Since relatively too much or too little early FV is associated with mortality, FV should be continuously moni- tored and managed according to AP severity. Copyright © 2011 S. Karger AG, Basel and IAP Introduction Acute pancreatitis (AP) is often encountered in al- ready critically ill patients; it affects an estimated 14,500 patients in Japan, annually [1]. The overall mortality rate of AP patients is between 2 and 10%, and is as high as 27% in cases with severe AP and complicated conditions, such as multiple organ failure (MOF) and concomitant sepsis [1–3]. Numerous studies on the management strategy of this critical illness have been published and have contrib- uted to the establishment of several types of clinical guidelines for the management of AP [2, 4–8]. Key Words Acute pancreatitis therapy  Fluid volume management  Critical care  Mortality Abstract Aims: Guidelines recommend aggressive fluid resuscitation in patients with acute pancreatitis (AP) to minimize organ failure. This study aimed to determine whether early crystal- loid fluid management is associated with mortality and/or critical care. Methods: 9,489 AP patients aged 6 18 years were categorized into four study groups: ventilation, hemo- dialysis, a combination of ventilation and hemodialysis, and neither ventilation nor hemodialysis. We analyzed demo- graphics, mortality, comorbidities, complications, AP sever- ity, surgery of the biliary/pancreatic system, and fluid vol- ume (FV) during the initial 48 h (FV48) and during hospital- ization (FVH), and calculated the FV ratio (FVR) as FV48/FVH. The impact of FV48 and FVR on mortality and the care pro- cess was assessed according to AP severity. Results: 1.1% of AP patients received ventilation, 1.7% received hemodialysis and 1.0% received both treatments. FV48 and FVR were higher in patients requiring ventilation compared with those Received: January 10, 2011 Accepted after revision: April 28, 2011 Published online: July 14, 2011 Kazuaki Kuwabara, MD, MPH, DPH Department of Health Care Administration and Management Graduate School of Medical Sciences, Kyushu University 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan) Tel. +81 92 642 6956, E-Mail kazu228  @  basil.ocn.ne.jp © 2011 S. Karger AG, Basel and IAP 1424–3903/11/0113–0351$38.00/0 Accessible online at: www.karger.com/pan