Lactated Ringer’s Solution Reduces Severity, Mortality, Systemic and Local Complications in Acute Pancreatitis: A Systematic Review and Meta-Analysis
Fluid therapy is the cornerstone of early supportive therapy in acute pancreatitis (AP). Regrettably, the type of fluid is still debated among clinicians, despite recent evidence from randomized controlled trials (RCTs). We aimed to incorporate all evidence from RCTs comparing lactated Ringer’s solu...
| Egile Nagusiak: | , , , |
|---|---|
| Formatua: | Artikulua |
| Hizkuntza: | English |
| Argitaratua: |
MDPI AG
2023-01-01
|
| Saila: | Biomedicines |
| Gaiak: | |
| Sarrera elektronikoa: | https://www.mdpi.com/2227-9059/11/2/321 |
| _version_ | 1827758514570788864 |
|---|---|
| author | Klementina Ocskay Péter Mátrai Péter Hegyi Andrea Párniczky |
| author_facet | Klementina Ocskay Péter Mátrai Péter Hegyi Andrea Párniczky |
| author_sort | Klementina Ocskay |
| collection | DOAJ |
| description | Fluid therapy is the cornerstone of early supportive therapy in acute pancreatitis (AP). Regrettably, the type of fluid is still debated among clinicians, despite recent evidence from randomized controlled trials (RCTs). We aimed to incorporate all evidence from RCTs comparing lactated Ringer’s solution (LR) with normal saline (NS) in adult and pediatric AP patients, with particular emphasis on clinically relevant outcomes. We evaluated RCTs comparing intravenous fluid resuscitation with LR to NS in adult or pediatric AP patients according to a prospectively registered protocol (CRD42021224542). Moderate-to-severe AP (MSAP), mortality, length of hospitalization (LoH), need for intensive care, the incidence of systemic (organ failure, OF) and local complications (in total), necrosis and pseudocyst formation were analyzed separately. Risk ratio (RR) and median difference (MD) were calculated with 95% confidence intervals (CI) using a random effect model. Risk of bias and quality of evidence were assessed. Altogether, 8 eligible RCTs were found, including 557 patients (LR: 278; NS: 279). LR reduced the risk of MSAP by 31% (RR: 0.59, 95% CI: 0.36–0.97, high quality) and the risk of death by 62% (RR: 0.48; 95% CI: 0.24–0.98, very low quality). LR was associated with a significantly lower risk of need for intensive care (RR: 0.50, 95% CI: 0.33–0.77), OF (RR: 0.78, 95% CI: 0.61–0.99) and local complications (RR: 0.64, 95% CI: 0.46–0.89). No significant risk reduction was observed for LoH (MD: −0.57 days, CI: −1.33–0.19), necrosis, pseudocyst and inflammatory parameters by LR compared to NS. LR reduces severity, mortality, need of intensive care and systemic and local complications in AP. |
| first_indexed | 2024-03-11T09:07:26Z |
| format | Article |
| id | doaj.art-e3dcec58bac24616b1e8edabf10c8ff3 |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-11T09:07:26Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-e3dcec58bac24616b1e8edabf10c8ff32023-11-16T19:16:29ZengMDPI AGBiomedicines2227-90592023-01-0111232110.3390/biomedicines11020321Lactated Ringer’s Solution Reduces Severity, Mortality, Systemic and Local Complications in Acute Pancreatitis: A Systematic Review and Meta-AnalysisKlementina Ocskay0Péter Mátrai1Péter Hegyi2Andrea Párniczky3Heim Pál National Pediatric Institute, 1089 Budapest, HungaryInstitute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, HungaryInstitute for Translational Medicine, Medical School, University of Pécs, 7623 Pécs, HungaryHeim Pál National Pediatric Institute, 1089 Budapest, HungaryFluid therapy is the cornerstone of early supportive therapy in acute pancreatitis (AP). Regrettably, the type of fluid is still debated among clinicians, despite recent evidence from randomized controlled trials (RCTs). We aimed to incorporate all evidence from RCTs comparing lactated Ringer’s solution (LR) with normal saline (NS) in adult and pediatric AP patients, with particular emphasis on clinically relevant outcomes. We evaluated RCTs comparing intravenous fluid resuscitation with LR to NS in adult or pediatric AP patients according to a prospectively registered protocol (CRD42021224542). Moderate-to-severe AP (MSAP), mortality, length of hospitalization (LoH), need for intensive care, the incidence of systemic (organ failure, OF) and local complications (in total), necrosis and pseudocyst formation were analyzed separately. Risk ratio (RR) and median difference (MD) were calculated with 95% confidence intervals (CI) using a random effect model. Risk of bias and quality of evidence were assessed. Altogether, 8 eligible RCTs were found, including 557 patients (LR: 278; NS: 279). LR reduced the risk of MSAP by 31% (RR: 0.59, 95% CI: 0.36–0.97, high quality) and the risk of death by 62% (RR: 0.48; 95% CI: 0.24–0.98, very low quality). LR was associated with a significantly lower risk of need for intensive care (RR: 0.50, 95% CI: 0.33–0.77), OF (RR: 0.78, 95% CI: 0.61–0.99) and local complications (RR: 0.64, 95% CI: 0.46–0.89). No significant risk reduction was observed for LoH (MD: −0.57 days, CI: −1.33–0.19), necrosis, pseudocyst and inflammatory parameters by LR compared to NS. LR reduces severity, mortality, need of intensive care and systemic and local complications in AP.https://www.mdpi.com/2227-9059/11/2/321acute pancreatitisfluid therapyresuscitationcrystalloid |
| spellingShingle | Klementina Ocskay Péter Mátrai Péter Hegyi Andrea Párniczky Lactated Ringer’s Solution Reduces Severity, Mortality, Systemic and Local Complications in Acute Pancreatitis: A Systematic Review and Meta-Analysis Biomedicines acute pancreatitis fluid therapy resuscitation crystalloid |
| title | Lactated Ringer’s Solution Reduces Severity, Mortality, Systemic and Local Complications in Acute Pancreatitis: A Systematic Review and Meta-Analysis |
| title_full | Lactated Ringer’s Solution Reduces Severity, Mortality, Systemic and Local Complications in Acute Pancreatitis: A Systematic Review and Meta-Analysis |
| title_fullStr | Lactated Ringer’s Solution Reduces Severity, Mortality, Systemic and Local Complications in Acute Pancreatitis: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Lactated Ringer’s Solution Reduces Severity, Mortality, Systemic and Local Complications in Acute Pancreatitis: A Systematic Review and Meta-Analysis |
| title_short | Lactated Ringer’s Solution Reduces Severity, Mortality, Systemic and Local Complications in Acute Pancreatitis: A Systematic Review and Meta-Analysis |
| title_sort | lactated ringer s solution reduces severity mortality systemic and local complications in acute pancreatitis a systematic review and meta analysis |
| topic | acute pancreatitis fluid therapy resuscitation crystalloid |
| url | https://www.mdpi.com/2227-9059/11/2/321 |
| work_keys_str_mv | AT klementinaocskay lactatedringerssolutionreducesseveritymortalitysystemicandlocalcomplicationsinacutepancreatitisasystematicreviewandmetaanalysis AT petermatrai lactatedringerssolutionreducesseveritymortalitysystemicandlocalcomplicationsinacutepancreatitisasystematicreviewandmetaanalysis AT peterhegyi lactatedringerssolutionreducesseveritymortalitysystemicandlocalcomplicationsinacutepancreatitisasystematicreviewandmetaanalysis AT andreaparniczky lactatedringerssolutionreducesseveritymortalitysystemicandlocalcomplicationsinacutepancreatitisasystematicreviewandmetaanalysis |