Early magnesium sulphate catharsis reduces severe acute pancreatitis and mortality in high-risk patients

ABSTRACT Background and Aims: Acute pancreatitis (AP) can lead to systemic inflammatory response (SIRS), paralytic intestinal obstruction, and in severe cases, intra-abdominal hypertension (IAH), organ failure (OF), and even death. Early magnesium sulphate (MS) catharsis treatment can relieve paralytic intestinal obstruction and IAH, thus reducing the incidence of severe acute pancreatitis (SAP) as well as mortality. Methods: 850 patients with AP at high risk of systemic complications (potential SAP (p-SAP)) were recruited. These p-SAP patients were categorized into two groups based on the treatment they received: the routine group (RT group, standard treatment for AP) and the MS group (early MS catharsis added to standard treatment). The final cohort had an allocation ratio of 2.5:1 (RT : MS). The primary composite endpoints were clinically finally diagnosed SAP (d-SAP) and mortality. The intensive care unit (ICU) admission, OF, inflammatory factors, length of hospital stay, and hospitalization costs, etc. were also compared and analyzed. Results: It demonstrated that early MS catharsis treatment was highly effective in preventing patients with p-SAP of various aetiologies from deteriorating to d-SAP and reducing their mortality significantly. In addition, it significantly reduced the incidence of OFs, pancreatic necrosis, ICU admissions, CRRT utilisation, and the cost and length of stay of hospitalisation for these patients. Conclusions: It showed that early MS catharsis had a significant therapeutic effect on p-SAP patients, which would profoundly contribute to the clinical management of AP. Keywords: acute pancreatitis, severe acute pancreatitis, clinical retrospective cohort study, catharsis, magnesium sulphate.