Non-aggressive Lactated Ringer's resuscitation improves outcomes and has a favorable safety profile in acute pancreatitis: a comprehensive systematic review and component network meta-analysis of Randomized Controlled Trials using GRADE and CINeMA approaches.
Vincenzo D'Ambra, Claudio Ricci, Carlo Ingaldi et al.
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In 30 seconds
This component network meta-analysis of 12 randomized trials involving 1,216 patients with new-onset acute pancreatitis compared fluid types and resuscitation strategies. Lactated Ringer’s solution (LR) was associated with lower odds of progression to moderately severe or severe pancreatitis than other fluid components (iOR 0.51; 95% CI 0.33; 0.79), and fewer pancreatitis-related local complications. Aggressive resuscitation increased adverse events (iOR 3.35; 95% CI 1.52; 7.37). The authors conclude that LR within a moderate, goal-directed strategy may improve outcomes, while noting generally low-to-moderate evidence certainty.
Key findings
- LR reduced progression to moderately severe or severe acute pancreatitis (iOR 0.51; 95% CI 0.33; 0.79).
- LR reduced pancreatitis-related local complications (iOR 0.53; 95% CI 0.33; 0.85).
- Aggressive resuscitation increased adverse events (iOR 3.35; 95% CI 1.52; 7.37).
- Compared with normal saline, BMES and LR reduced length of stay by approximately 4 and 1 day, respectively.
Why it matters
Early fluid resuscitation is common in acute pancreatitis, but both fluid composition and intensity may affect outcomes. This synthesis suggests that LR and less aggressive resuscitation could offer a more favorable balance than normal saline or aggressive regimens. The findings are clinically relevant but should be interpreted in light of the review’s low-to-moderate certainty of evidence.
What to keep in mind
Evidence certainty was generally low to moderate, with risk of bias and imprecision noted by the authors.