Effect of Different-Volume Fluid Resuscitation on Organ Functions in Severe Acute Pancreatitis and Therapeutic Effect of Poria cocos

Xiao-Lin Yi; Jing Hu; Qiu-Ting Wu; Yu-Mei Zhang; Qian Hu; Ling Yuan; Yi-Fan Miao; Huan Chen; Lv Zhu; Juan Li; Xian-Lin Zhao; Jia-Qi Yao; Xiao-Yu Dai; Mei-Hua Wan; Wen-Fu Tang

doi:10.1155/2020/6408202

Effect of Different-Volume Fluid Resuscitation on Organ Functions in Severe Acute Pancreatitis and Therapeutic Effect of Poria cocos

Evid Based Complement Alternat Med. 2020 Oct 14:2020:6408202. doi: 10.1155/2020/6408202. eCollection 2020.

Authors

Xiao-Lin Yi^#¹, Jing Hu^#^{1

2}, Qiu-Ting Wu¹, Yu-Mei Zhang³, Qian Hu¹, Ling Yuan¹, Yi-Fan Miao¹, Huan Chen¹, Lv Zhu¹, Juan Li¹, Xian-Lin Zhao¹, Jia-Qi Yao¹, Xiao-Yu Dai¹, Mei-Hua Wan¹, Wen-Fu Tang¹

Affiliations

¹ Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
² Department of Gastroenterology, Leshan Municipal Hospital of Traditional Chinese Medicine, Leshan 614000, China.
³ Department of Traditional Chinese Medicine, Xiang'an Hospital of Xiamen University, Xiamen 361101, China.

^# Contributed equally.

Abstract

Objective: To explore the effect of different-volume fluid resuscitation (FR) on organ functions in severe acute pancreatitis (SAP) and to elucidate the therapeutic effect and mechanism of Poria cocos on organ injuries caused by high-volume FR.

Methods: 1. Clinical study: retrospective analysis of thirty-one patients about the effect of titrated fluid resuscitation protocol (TFR) on the occurrence of acute kidney injury (AKI) secondary to SAP. 2. Experimental study: rats (N = 30) were randomly divided into five groups: sham, model, low-volume FR (1.5 ml/kg/h), high-volume FR (10 ml/kg/h), and Poria cocos combined with high-volume FR (10 ml/kg/h + intraintestinal administration Poria cocos 5 g/kg); serum or plasma indicators and histopathologic scores were compared to explore the effect and mechanism of different fluid volumes and Poria cocos on organ function in SAP.

Results: The occurrence of AKI, fluid volume, and fluid velocity in TFR group was lower than that in the control group. Logistic regression analysis showed that increased Marshall scores and fluid velocity were risk factors for predicting occurrence of AKI in SAP. Low-volume FR decreased the levels of blood urea nitrogen (BUN), serum creatinine (Cr), matrix metalloproteinase (MMP), and pathologic scores of the pancreas and kidney. High-volume FR increased ascites, MMPs, and kidney pathologic scores. Poria cocos decreased the levels of BUN, Cr, MMPs, and pathologic scores of the pancreas and kidney and increased the arterial oxygen saturation.

Conclusion: TFR-associated lower fluid volume and velocity reduced the occurrence of AKI secondary to SAP. High volume might aggravate AKI via increased MMP release leading to endothelial glycocalyx damage and vascular endothelial dysfunction. Poria cocos reduced MMP release, relieved glycocalyx damage, and alleviated the pancreas and kidney injury aggravated by high fluid volume in SAP. Therefore, endothelial glycocalyx protection might be a new strategy in the treatment of SAP.