Dynamic fluid therapy strategies in acute pancreatitis can significantly impact patient mortality.

• Identified five dynamic fluid therapy trajectories within the first 72 hours: low stable (7.3%), low-moderate sustained (10.8%), moderate stable (66.0%), moderate-high fluctuating (7.4%), and high sustained (8.6%).
• Hazard ratios reveal increased in-hospital mortality: moderate-high fluctuating group (2.08) and high sustained group (2.91) compared to moderate stable.

Monitoring fluid therapy intensively could help tailor management and improve patient outcomes.

• A 1 standard deviation increase in cumulative fluid therapy correlates with a 47% heightened mortality risk.