Dextran 40 Plus Ringer's Lactate Vs. Ringer's Lactate Alone for Fluid Resuscitation in Acute Pancreatitis

Detailed Description Acute pancreatitis (AP) is a common gastrointestinal disorder requiring hospitalization, with an incidence of approximately 40 cases per 100,000 individuals. The severity of AP ranges from mild to severe, with 15-20% of cases progressing to severe acute pancreatitis (SAP), which is characterized by organ failure and local complications. The mortality rate for severe acute pancreatitis remains high, reaching 20-30%, highlighting the critical need for early and adequate fluid resuscitation in emergency settings.

Despite universal recommendations for early-volume resuscitation, there is no clear consensus regarding the optimal fluid type, infusion rate, total volume, or monitoring strategy. Fluid resuscitation's primary objective is to prevent or minimize systemic inflammatory response syndrome (SIRS), which significantly contributes to AP progression.

This randomized controlled trial (RCT) will compare the effectiveness of a colloid-crystalloid combination (Dextran 40 in sodium chloride [NaCl] 0.9 grams per liter [g/L] solution and Ringer's lactate solution in a 1:3 ratio) versus Ringer's lactate solution alone in preventing disease progression and reducing complications in patients with mild or moderate AP.

Study Design This randomized clinical trial (RCT) will be conducted at Satu Mare County Emergency Hospital and enroll approximately 100 patients diagnosed with mild or moderate AP.

Fluid Administration Rate: 1,5 mL/kg/h, based on patient hemodynamic status.

• Data Collection and Assessment
• Clinical and Demographic Data:
• Age, sex.
• Lifestyle factors (alcohol consumption, smoking).
• Symptom onset time and severity classification (based on the Revised Atlanta -Classification, 2012).

=Diagnostic Criteria (Requires ≥2 of 3):

• Acute upper abdominal pain.
• Serum amylase/lipase levels ≥3 times the upper standard limit (ULN).
• Imaging findings (CT, ultrasound, or MRI) consistent with AP.

Organ Failure Assessment:

-Modified Marshall Scoring System (2012).

Severity Scoring:

• Modified Glasgow Score.
• Acute Physiology and Chronic Health Evaluation II (APACHE II).
• Bedside Index for Severity in Acute Pancreatitis (BISAP).
• CT Severity Index.

Laboratory Biomarkers & Monitoring

Blood samples will be collected at admission and every 24 hours to assess:

• Pancreatic Enzymes: Amylase, lipase.
• Inflammatory Markers & Organ Function Parameters:
• C-reactive protein (CRP).
• Erythrocyte sedimentation rate (ESR).
• Hematocrit.
• Urea, creatinine.
• Systemic inflammatory response syndrome (SIRS) markers.
• Fibrinogen, ferritin.
• Procalcitonin at enrollment and 72 hours.

Additional Monitoring:

An ultrasound will measure the Inferior vena cava (IVC) diameter and collapsibility index to estimate central venous pressure (CVP) and hemodynamic status.

Urine output every 24 hours (target ≥0.5 mL/kg/h as an adequate resuscitation marker).

Primary and Secondary Outcome Measures

Primary Outcomes:

Reduction in C-reactive protein (CRP) and SIRS

Secondary Outcomes:

• Reduced duration of hospitalization and lower ICU admission rates.
• Reduction of erythrocyte sedimentation rate (ESR) and other inflammatory markers.
• Complication rates (e.g., pancreatic necrosis, organ failure).
• Hospitalization costs.
• In-hospital mortality and follow-up mortality at 3 months.

Follow-up and Study Endpoints Patients will be monitored throughout hospitalization and followed up at 12 weeks post-discharge.

Expected Impact This study aims to identify the optimal fluid resuscitation strategy for mild and moderate AP. If the colloid-crystalloid combination proves superior, it could lead to changes in clinical guidelines for AP management, potentially reducing organ failure, ICU admissions, and mortality rates.

Inclusion criteria

• adults (≥18 years) diagnosed with mild or moderate acute pancreatitis
• must provide written informed consent for study participation.

Exclusion criteria

• patients who decline to provide informed consent.
• patients are non-compliant with treatment and follow-up visits.
• pregnant individuals.
• patients requiring concomitant treatment that is contraindicated within the study protocol.
• patients who develop conditions that contraindicate the administration of the investigational medication.
• patients experiencing severe adverse reactions necessitating treatment discontinuation.