BJS 02 Comparing Aggressive versus Moderate or Goal-Directed Resuscitation Strategies in Acute Pancreatitis: A Systematic Review and Meta-Analysis
Ali Yousaf, Aneeka Pervez, Veylan Sebastian, David Antcliffe, Brian Davidson, Farid FroghiAbstract
Aims
To compare the clinical effectiveness of aggressive versus goal-directed fluid resuscitation strategies in adult patients with acute pancreatitis, and to evaluate their impact on all-cause mortality, disease severity progression, organ failure, systemic inflammatory response syndrome (SIRS), and treatment-related complications.
Methods
A systematic review and meta-analysis was conducted following PRISMA guidelines. Studies were identified using a modified PICOS framework comparing aggressive and goal-directed fluid resuscitation. Outcomes included mortality, disease severity, SIRS, and organ failure. Statistical analysis employed the DerSimonian- Laird random-effects model, with effect sizes calculated as odds ratios (OR) with 95% confidence intervals (CI). Methodological quality was assessed using the Cochrane Risk of Bias 2.0 tool. Evidence certainty was evaluated using the GRADE framework.
Results
14 studies involving 1,324 participants were included. Aggressive fluid resuscitation was associated with significantly higher all-cause mortality compared to moderate resuscitation (OR: 1.68; 95% CI: 1.12–2.51; p<0.05; I²=0.0%). Aggressive resuscitation significantly increased the overall risk of organ failure (OR: 1.59; 95% CI: 1.13–2.23; p<0.05; I²=35.7%), primarily driven by respiratory failure (OR: 1.59; 95% CI: 1.07–2.35; p<0.05; I²=42.1%). No significant difference were found for renal or cardiovascular failure or SIRS. Aggressive resuscitation was further associated with fluid overload, prolonged hospital stay and required more invasive interventions.
Conclusion
Aggressive fluid resuscitation increases mortality and risk of organ failure without demonstrable benefits in preventing disease progression. Goal-directed fluid regimes provide comparable efficacy but with a superior safety profile, supporting current guideline recommendations for dynamically guided resuscitation strategies.