A0020 - Fluid Administration and Severity of Acute Pancreatitis Stratified by BISAP Score - Retrospective Cohort Study

Introduction: Fluid administration is a standard of care in managing patients with acute pancreatitis (AP). There are many gaps in our knowledge. There is no study has been conducted to assess fluid administration in patients with predicted AP severity on presentation and it is effect on AP severity. In this study we aimed to evaluate the association between the fluid administration, and it is effect on AP severity defined according to Modified Atlanta Criteria in patients with AP stratified by Bedside Index for Severity in Acute Pancreatitis (BISAP) score in the first 24-48h.

Methods: We included adult patients with AP admitted to our tertiary center between 2017 and 2019. Patients were stratified based on their BISAP scores in to low and high score groups ≤ 2 and ≥ 3 respectively. Volumes of fluid received in the first 24, 48, and 72 hours from admission were measured. Outcomes included severity of AP as defined by the modified Atlanta and ICU.

Results: 444 patients were included. 409 with BISAP of ≤2 and 35 with BISAP of ≥3. 25.9% of patients with BISAP score ≤2 and 62.9% with BISAP score ≥3 developed Moderate-Severe (M-S) AP (p< 0.001). The probability of M-S AP by the volume of fluid intake in the first 24h was not different when patients were stratified by BISAP score (p = .548). A clear trend noted of lower probability of M-S AP by fluid intake given in the first 48h (p = .069). When stratified by BISAP scores, there was no difference in the probability of developing M-S AP and fluid intake in the first 48. The probability of M-S AP by fluid intake from 48-to-72h was higher in all patients regardless of their BISAP score (p = .044). This probability was higher in patients with lower BISAP scores (p = .403). The probability of being admitted to the ICU by fluid intake from 48-to-72 h was higher in patients with low BISAP score (p = .157).

Discussion: Higher fluid intake in the first 48h is associated with lower probability of developing moderate-severe pancreatitis (M-S AP). The overall trend of better outcomes is likely driven by patients with a higher BISAP scores. Additional fluid volume given between 48-72hrs revealed statistically significant worse outcomes for all patients with AP. This was likely driven by patients with BISAP scores ≤2. Increased probability of being admitted to the ICU with higher fluid intake from 48-72h was likely related to increased rates of fluid overload and respiratory failure in these patients with lower BISAP.