Ringer’s lactate associated with better outcomes in acute pancreatitis

The administration of Ringer’s lactate in the first 24 hours of hospital admission is associated with better outcomes in acute pancreatitis compared to physiological saline. This is evident from international research based on the APPRENTICE study.

Previous pilot studies have already shown that the use of Ringer’s lactate can improve the outcomes of patients with acute pancreatitis compared to physiological saline. However, these were mostly single-center studies with a small sample size and a low incidence of moderate to severe pancreatitis. This international multicenter study therefore investigated whether there is an association between the type of fluid administered and the clinical outcome in patients with moderate/severe acute pancreatitis who participated in the APPRENTICE study. Between 2015 and 2018, patients with acute pancreatitis from 22 centers were included immediately upon admission. Demographic data, data on fluids administered, and severity of acute pancreatitis were collected in a standardized prospective manner to investigate the association between the type of fluid administered during the first 24 hours and the development of moderate/severe acute pancreatitis.

Data from 999 patients could be analyzed (mean age 51 years, 52% female, moderate/severe AP 24%). The use of Ringer’s lactate during the first 24 hours was associated with a lower risk of moderate/severe acute pancreatitis (adjusted OR 0.52; p = 0.014) compared to normal saline, after adjustment for region of inclusion, etiology, BMI and fluid volume, taking into account variation between centers. Similar results were observed in sensitivity analyzes in which the effect of organ failure on admission, post-ERCP etiology and excessive fluid administration (>4 liters within 24 hours) was eliminated.

Source:

Lee PJ, Culp S, Kamal A, et al. Lactated Ringers Use in the First 24 Hours of Hospitalization Is Associated With Improved Outcomes in 999 Patients With Acute Pancreatitis. Am J Gastroenterol. 2023;118:2258-66.