DOI: 10.1097/meg.0000000000003273 ISSN: 0954-691X

Impact of restrictive fluid resuscitation strategy on early intestinal epithelial injury markers and inflammatory cytokine levels in patients with acute pancreatitis

AMei Huang, Yizhi Liang
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Background

Optimal fluid resuscitation for acute pancreatitis remains debated; aggressive therapy may impair intestinal epithelial integrity and worsen inflammatory cascades.

Objective

This study compared restrictive versus conventional fluid resuscitation on intestinal injury markers, inflammatory cytokines, and clinical outcomes in acute pancreatitis patients.

Methods

This prospective observational cohort study enrolled 150 acute pancreatitis patients from January 2024 to May 2025, assigned to restrictive fluid resuscitation (RFR, n = 82) or conventional fluid resuscitation (CFR, n = 68) groups by protocol timing. RFR received 10 ml/kg bolus only for hypovolemia plus 1.5 ml/kg/h maintenance; CFR received 15 ml/kg bolus plus 2.5–3.0 ml/kg/h. Primary outcomes were intestinal injury markers and inflammatory cytokines measured at baseline, 24, 48, and 72 h; secondary outcomes included fluid overload, organ complications, and clinical endpoints.

Results

The RFR group received significantly less fluid (68.5 ± 24.3 vs. 89.7 ± 28.6 mL/kg/day; P = 0.002). At 48 h, RFR patients had lower D-lactate, intestinal fatty acid-binding protein, and intra-abdominal pressure (all P < 0.05), with reduced tumor necrosis factor alpha and interleukin-6 at both 48 and 72 h ( P < 0.05). Fluid overload was less frequent in RFR (8.5 vs. 23.5%; P = 0.014). No significant differences were seen in major organ complications or 30-day mortality.

Conclusion

The RFR strategy was associated with reduced intestinal epithelial injury markers and attenuated systemic inflammatory response compared with conventional fluid management while significantly reducing fluid overload without compromising clinical safety outcomes in acute pancreatitis patients.

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