RESUMO
Abstract Acute pancreatitis (AP) requires first-line treatment with intensive fluid resuscitation. Hydroelectrolyte changes secondary to this management could be related to an increase in hospital stay, complications, and mortality. The objective of this study was to correlate the increase in serum chlorine (> 8mEq / L) during the first 24 hours (ISC) with a longer hospital stay, complications and mortality in patients with AP. A total of 110 patients with AP admitted to the emergency room were included. Fluid management and serum chlorine were recorded on admission and after 24 hours; duration of hospital stay, complications and mortality, were also registered. 37 patients had ISC (age 56.4 ± 18.4 years; 51% women), there were no differences in age, sex or type of fluid management with patients without ISC. In bivariate analysis, ISC was associated with severe AP (30% vs 12%, p = 0.02), higher APACHE II score at admission (8 [6-15] vs 6 [4-9] points, p = 0.006), and longer hospital stay (9 [7-12] vs 7 [5-10] days, p = 0.03). The overall mortality and complications rate were 16% and 25%, respectively, with no differences between the groups (24% vs. 12%, p = 0.1 and 35% vs. 19%, p = 0.06). After multivariate adjustment, independent predictors of hospital stay were ISC> 8 mEq / L (p = 0.01) and APACHE II scores at 24 hours (p = 0.02). We conclude that ISC is associated with a longer hospital stay in patients with AP from a second-level hospital care population.
Resumen La pancreatitis aguda (PA) requiere tratamiento de primera línea con reanimación hídrica intensiva. Los cambios hidroelectrolíticos secundarios a este manejo podrían relacionarse a un incremento en la estancia hospitalaria, complicaciones y mortalidad. El objetivo de este estudio fue correlacionar el incremento de cloro sérico (>8mEq/L) en las primeras 24hrs (ICS), con una mayor estancia hospitalaria, complicaciones y mortalidad en pacientes con PA. Se incluyeron 110 pacientes con PA ingresados a urgencias, se registró el manejo hídrico y cloro sérico al ingreso y 24 horas después, la estancia hospitalaria, complicaciones y mortalidad. 37 pacientes tuvieron ICS (edad 56,4 ± 18,4 años; 51% mujeres) no hubo diferencias en edad, sexo o tipo de manejo hídrico en pacientes sin ISC. En el análisis bivariado, el ICS se asoció a PA grave (30% vs 12%, p = 0,02), mayor puntuación APACHE II al ingreso (8 [6-15] vs 6 [4-9] puntos, p = 0,006) y estancia hospitalaria más prolongada (9 [7-12] frente a 7 [5-10] días, p = 0,03). La tasa global de mortalidad y complicaciones fueron del 16% y el 25%, respectivamente, sin diferencias entre grupos (24% vs 12%, p = 0,1 y 35% vs 19%, p = 0,06). Después del ajuste multivariado, los predictores independientes de la estancia hospitalaria fueron ICS> 8 mEq/L (p = 0,01) y las puntuaciones APACHE II a las 24 horas (p = 0,02). Concluimos que el ICS se asocia a mayor estancia hospitalaria en pacientes con PA de una población de segundo nivel de atención hospitalaria.