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Comparison of Fluid Resuscitation with Lactate Ringer's Versus Normal Saline in Acute Pancreatitis: An Updated Meta-Analysis

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Abstract

Background

Fluid resuscitation is one of the main therapies for acute pancreatitis (AP). There is still no consensus on the type of fluid resuscitation. This study investigated the differences between lactate Ringer’s (LR) and normal saline (NS) in treating AP.

Methods

Two authors systematically searched Web of Science, Embase (via OVID), Cochrane Library, and PubMed to find all published research before July, 2023. The odds of moderately severe/severe AP and intensive care unit (ICU) admission are set as primary endpoints.

Results

This meta-analysis included 5 RCTs and 4 observational studies with 1424 AP patients in LR (n = 651) and NS (n = 773) groups. The results suggested that the odds of moderately severe/severe AP (OR 0.48; 95%Cl 0.34 to 0.67; P < 0.001) and ICU admission (OR 0.37; 95%Cl 0.16 to 0.87; P = 0.02) were lower in the LR group compared to NS group. In addition, the LR group had lower rates of local complications (OR 0.54; 95%Cl 0.32 to 0.92; P = 0.02), lower level of CRP, as well as a shorter hospital stay (WMD, − 1.09 days; 95%Cl − 1.72 to − 0.47 days; P < 0.001) than the NS group. Other outcomes, such as mortality, the rate of organ failure, SIRS, acute fluid collection, pancreatic necrosis, pseudocysts, and volume overload, did not differ significantly between two groups (P > 0.05).

Conclusions

LR is preferred over NS as it decreases the odds of moderately severe/severe AP, the rate of ICU admission, local complication, and length of hospital stay. However, large-scale RCT are lacking to support these evidence.

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Data availability

The datasets supporting the conclusions of this article are included within the article. If you want detailed data about this article, please contact the corresponding author.

Abbreviations

AP:

Acute pancreatitis

NS:

Normal saline

LR:

Lactate Ringer’s

RCT:

Randomized controlled trial

OR:

Odds risks

CI:

Confidence intervals

WMD:

Weighted mean difference

SIRS:

Systemic inflammatory response syndrome

ERCP:

Endoscopic retrograde cholangopancreatography

CRP:

C-reactive protein

ICU:

Intensive care unit

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Acknowledgments

None.

Funding

This work was supported by the National Natural Science Foundation of China (Nos. 81974068 and 81770539). The funders had no role in the design of the study, data collection and analysis, interpretation of data, and in writing the manuscript.

Author information

Author notes

  1. Jiaze Hong, Qingyuan Li and Mengke Fan share the co-first author.

Authors and Affiliations

  1. Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China

    Jiaze Hong, Mengke Fan & Rong Lin

  2. The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China

    Qingyuan Li

  3. Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Jinhua, China

    Yiran Wang

  4. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Lizhi Xiang

  5. Department of Neurosurgery, Affiliated Hospital, Shaoxing University, Shaoxing, China

    Yifu Zhou

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Contributions

Each author contributed significantly to the conception and development of the present paper. RL, MF, and JH designed the research process. JH and QL searched the database for corresponding articles, extracted useful information from the articles above. YW, LX, and YZ used statistical software for analysis. JH and QL drafted the manuscript. RL and MF supervised, reviewed, and revised the manuscript. All authors have read and approved the final version of this manuscript.

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Correspondence to Rong Lin.

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Hong, J., Li, Q., Wang, Y. et al. Comparison of Fluid Resuscitation with Lactate Ringer's Versus Normal Saline in Acute Pancreatitis: An Updated Meta-Analysis. Dig Dis Sci 69, 262–274 (2024). https://doi.org/10.1007/s10620-023-08187-7

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