University of Toledo Medical Center Maumee, OH, United States
Award: Presidential Poster Award
Muhammad Aziz, MD1, Zohaib Ahmed, MD2, Simcha Weissman, MD3, Sami Ghazaleh, MD1, Azizullah Beran, MD1, Faisal Kamal, MD4, Wade Lee-Smith, MD1, Ragheb Assaly, MD1, Stephen Pandol, MD5, Stephanie McDonough, MD6, Douglas G. Adler, MD6, Ali Nawras, MD1 1University of Toledo Medical Center, Toledo, OH; 2University of Toledo Medical Center, Maumee, OH; 3Hackensack Meridian Palisades Medical Center, North Bergen, NJ; 4University of Tennessee Health Science Center, Memphis, TN; 5Cedars-Sinai Medical Center, Los Angeles, CA; 6University of Utah School of Medicine, Salt Lake City, UT
Introduction: Recent studies have evaluated and compared the efficacy of normal saline (NS) and lactated Ringer’s (LR) in reducing the severity of acute pancreatitis (AP) and improving outcomes such as length of stay, the occurrence of the systemic inflammatory response syndrome (SIRS), ICU admission and mortality. We performed an updated systematic review and meta-analysis of the available studies to assess the impact of these fluids on outcomes secondary to AP.
Methods: We systematically searched the following databases: PubMed/Medline, Embase, Cochrane, and Web of Science through February 8th, 2021 to include randomized controlled trials (RCTs) and cohort studies. Random effects model using the DerSimonian-Laird approach was employed and risk ratios (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated for binary and continuous outcomes, respectively.
Results: 6 studies (4 RCTs and 2 cohort studies) with 549 (230 in LR and 319 in NS) were included. The overall mortality (RR: 0.73, CI: 0.31 – 1.69) and SIRS at 24 hours (RR: 0.69, CI: 0.32 – 1.51) were not significantly different. The overall ICU admission was lower in the LR group compared to the NS group (RR: 0.43, CI: 0.22 – 0.84). Subgroup analysis of RCTs demonstrated a lower length of hospital stay for the LR group compared to the NS group (MD: -0.77 days, CI: -1.44 –0.09 days).
Discussion: This systematic review and meta-analysis comparing LR and NS for fluid resuscitation in patients with acute pancreatitis found that LR was associated with decreased ICU admission. Further subgroup analysis of RCTs also showed a decreased length of stay for patients resuscitated with LR. While the rate of pancreatic necrosis reported in RCTs was lower than that of retrospective studies for the LR group, statistical significance was not achieved. Similarly, mortality and SIRS at 24 hours were lower for the LR group, however, the results did not achieve statistical significance.
Disclosures:
Muhammad Aziz indicated no relevant financial relationships.
Zohaib Ahmed indicated no relevant financial relationships.
Simcha Weissman indicated no relevant financial relationships.
Sami Ghazaleh indicated no relevant financial relationships.
Azizullah Beran indicated no relevant financial relationships.
Faisal Kamal indicated no relevant financial relationships.
Wade Lee-Smith indicated no relevant financial relationships.
Ragheb Assaly indicated no relevant financial relationships.
Stephen Pandol indicated no relevant financial relationships.
Stephanie McDonough indicated no relevant financial relationships.
Douglas Adler indicated no relevant financial relationships.
Ali Nawras indicated no relevant financial relationships.
Muhammad Aziz, MD1, Zohaib Ahmed, MD2, Simcha Weissman, MD3, Sami Ghazaleh, MD1, Azizullah Beran, MD1, Faisal Kamal, MD4, Wade Lee-Smith, MD1, Ragheb Assaly, MD1, Stephen Pandol, MD5, Stephanie McDonough, MD6, Douglas G. Adler, MD6, Ali Nawras, MD1. P2112 - Lactated Ringer’s vs Normal Saline for Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
