Fluid Resuscitation with Lactated Ringer vs. Normal Saline in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Clinical Trials.

Abstract

Background: Initial fluid therapy in acute pancreatitis is critical for modulating the systemic inflammatory response. The choice between Lactated Ringer and normal saline remains debated, given their potentially divergent impacts on disease progression and clinically relevant outcomes. The objective of this meta-analysis is to determine the effectiveness of one solution versus the other in patients with AP.

Methods: A systematic review of randomized clinical trials published between 2000 and 2024 was conducted through an exhaustive search in databases such as PubMed, ScienceDirect, LILACS, SCOPUS, Web of Science, Springer, Scielo, and Cochrane. The review protocol adhered to the recommendations established by PRISMA. The methodological quality of the selected studies was assessed using the Jadad scale, while statistical analyses were performed with RevMan 5.4^® and Jamovi 2.3.28^® software.

Results: Five trials with 299 patients showed that, in patients with AP, Lactated Ringer significantly reduced ICU admission (RR: 0.39; 95% CI: 0.18-0.85; p = 0.02) and the progression of pancreatitis (RR: 0.63; 95% CI: 0.40-0.98; p = 0.04). There was no significant difference in mortality or hospital stay (SMD: -0.89; 95% CI: -2.26 to 0.48; p = 0.23). No clear effects were observed on SIRS at 24, 48, and 72 h. CRP at 48 h was significantly lower with lactate (SMD: -3.91; 95% CI: -4.66 to -3.17; p < 0.00001), but not at 72 h.

Conclusions: The administration of Lactated Ringer in acute pancreatitis shows clinical and anti-inflammatory benefits, but the evidence is mostly of low quality.