Background Early fluid resuscitation is one of the main therapeutic strategies for acute pancreatitis (AP). This study investigated the effects of early aggressive and nonaggressive hydration on AP. Objectives The aim of this meta-analysis is to investigate the differences between aggressive and nonaggressive intravenous fluid resuscitation in AP. Design This study was based on publicly available data, all of which have been extracted from previous ethically approved studies. Data sources and methods Two authors systematically searched PubMed, Embase (via OVID), Web of Science, and Cochrane Library to find all published research before February 2023. In-hospital mortality were set as primary endpoints. Results This meta-analysis included seven randomized controlled trials (RCTs) and eight cohort studies with 4072 individuals in nonaggressive (n = 2419) and aggressive (n = 1653) hydration groups. The results showed that patients in the nonaggressive group had a lower mortality rate than those in the aggressive hydration group [relative risks (RR), 0.66; p = 0.02]. Subgroup analysis results showed that patients in the nonaggressive hydration group had lower mortality rates in RCTs (RR, 0.39; p = 0.001), studies conducted in Eastern countries (RR, 0.63; p = 0.002), and studies with severe pancreatitis (RR, 0.65; p = 0.02). In addition, the nonaggressive hydration group had lower rates of infection (RR, 0.62; p < 0.001), organ failure (RR, 0.65; p = 0.02), and shock (RR, 0.21; p = 0.02), as well as a shorter hospital stay (weighted mean difference, -1.63; p = 0.001) than the aggressive hydration group. Conclusions Early nonaggressive fluid resuscitation is associated with lower mortality, lower risk of organ failure and infection, and shorter hospital stays than aggressive fluid resuscitation. Registration prospero registration number CRD42023396388.

中文翻译：

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急性胰腺炎早期积极与非积极液体复苏的比较：一项荟萃分析。

背景早期液体复苏是急性胰腺炎（AP）的主要治疗策略之一。本研究调查了早期积极性和非积极性水合作用对 AP 的影响。目的 本荟萃分析的目的是探讨 AP 中积极和非积极静脉液体复苏之间的差异。设计 本研究基于公开数据，所有数据均摘自之前经伦理批准的研究。数据来源和方法 两位作者系统地检索了 PubMed、Embase（通过 OVID）、Web of Science 和 Cochrane 图书馆，以查找 2023 年 2 月之前所有已发表的研究。院内死亡率被设置为主要终点。结果 这项荟萃分析包括 7 项随机对照试验 (RCT) 和 8 项队列研究，涉及非攻击性补水组 (n = 2419) 和攻击性补水组 (n = 1653) 的 4072 名个体。结果显示，非积极补水组患者的死亡率低于积极补水组患者[相对风险（RR），0.66；p = 0.02]。亚组分析结果显示，随机对照试验（RR，0.39；p = 0.001）、在东方国家进行的研究（RR，0.63；p = 0.002）和重症胰腺炎研究（RR， 0.65；p = 0.02）。此外，非积极补水组的感染率（RR，0.62；p < 0.001）、器官衰竭率（RR，0.65；p = 0.02）和休克率（RR，0.21；p = 0.02）以及与积极补水组相比，住院时间更短（加权平均差，-1.63；p = 0.001）。结论 与积极液体复苏相比，早期非积极液体复苏与较低的死亡率、较低的器官衰竭和感染风险以及较短的住院时间相关。注册prospero注册号CRD42023396388。