Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2020; 26(10): 1098-1106
Published online Mar 14, 2020. doi: 10.3748/wjg.v26.i10.1098
Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies
Mohamed M Gad, C. Roberto Simons-Linares
Mohamed M Gad, Internal Medicine Department, Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, United States
C. Roberto Simons-Linares, Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Simons-Linares CR has formulated the concept/study idea, study design, review literature, manuscript drafting, writing; Gad MM has review the literature, contributed to metaanalysis design, statistical support, and manuscript drafting.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: This is study followed PRISMA guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: C. Roberto Simons-Linares, MD, MSc, Assistant Professor, Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
Received: October 4, 2019
Peer-review started: October 4, 2019
First decision: November 4, 2019
Revised: January 12, 2020
Accepted: February 21, 2020
Article in press: February 21, 2020
Published online: March 14, 2020

There is conflincting evidence on the intravenous fluid (IVF) strategy for acute pancreatitis (AP). We perform a metaanalysis of the available evidence.


To investigate if aggressive IVF therapy in AP patients is beneficial to decrease mortality and improve outcomes.


Metaanalysis of available randomized controlled trials and cohort studies comparing aggressive IVF vs non-aggressive IVF resuscitation.


There was no significant difference in mortality between the aggressive (n = 1229) and non-aggressive IVF (n = 1397) patients. Patients receiving aggressive IVF therapy had higher risk for acute kidney injury and acute respiratory distress syndrome. There also was no significant difference in the overall incidence of systemic inflammatory response syndrome, persistent organ failure, pancreatic necrosis when comparing both study groups.


Early aggressive IVF therapy did not improve mortality. Moreover, aggressive IVF therapy could potentially increase the risk for acute kidney injury and pulmonary edema leading to respiratory failure and mechanical ventilation. Studies are needed to investigate which subset of AP patients could benefit from aggressive IVF therapy.

Keywords: Acute pancreatitis, Intravenous fluid resuscitation, Aggressive fluid resuscitation

Core tip: Early aggressive intravenous fluid therapy did not improve mortality of acute pancreatitis patients and could potentially be harmful. The intravenous fluid therapy strategy in acute pancreatitis patients remains to be elucidated.