TOPLINE:

In patients admitted with acute pancreatitis, adequate intravenous fluid administration during the first 24 hours prevented the rise in blood urea nitrogen (BUN) levels but did not prevent the onset or persistence of systemic inflammatory response syndrome (SIRS).

METHODOLOGY:

• The severity of acute pancreatitis poses substantial prognostic challenges for healthcare clinicians, with new or persistent SIRS or elevated BUN levels indicating severe progression.
• Researchers examined the relationship between the rate of intravenous fluid administration, SIRS, and BUN levels. A moderately aggressive rate of fluid resuscitation was defined as a fluid rate exceeding 1.5 mL/kg/h per current American College of Gastroenterology guidelines.
• Patients admitted with a diagnosis of acute pancreatitis were prospectively enrolled from 22 international sites across four continents between 2015 and 2018.
• Analyses focused on fluid administration rates and volumes at 6 and 24 hours after presentation, BUN levels and SIRS status at presentation and at 24 hours, and clinical outcomes (disease severity, necrosis, and organ failure).

TAKEAWAY:

• At 6 hours from presentation, 950 patients received an average of 1173 mL of fluids at a rate of 2.59 mL/kg/h; at 24 hours, 957 patients received an average of 3251 mL of fluids at a rate of 1.81 mL/kg/h.
• Between admission and 24 hours, approximately 31% of patients had new-onset or persistent SIRS (9% new and 22% persistent), and 32% experienced an elevation in BUN levels.
• Each 1 mL/kg/h increase in fluid rate at 6 and 24 hours correlated with higher odds of persistent or new SIRS (odds ratio [OR], 1.33 at 6 hours; OR, 1.29 at 24 hours).
• Increased fluid rates were linked to decreased odds of BUN level elevation (OR, 0.88 at 6 hours; OR, 0.83 at 24 hours). The mean change in BUN level was -1.5 mg/dL in patients without SIRS vs 0.7 mg/dL in those with new or persistent SIRS (P = .005).

IN PRACTICE:

"Patients who are more ill receive more fluids, making it appear that fluids caused worse outcomes; however, SIRS likely drove the poor outcomes," the authors reported.

SOURCE:

The study was presented by Daniel Marino, MD, MBA, of NYU Langone Health in New York, at the American College of Gastroenterology (ACG) 2025 Annual Scientific Meeting in Phoenix, Arizona, on October 27, 2025.

LIMITATIONS: 

The study was observational, may have suffered selection bias, and used only average fluid rates, so boluses and timing were not captured. 

DISCLOSURES:

One author disclosed receiving grant/research support from AbbVie.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.