ARTICLE: PANCREAS

Lactated Ringers Use in the First 24 Hours of Hospitalization Is Associated With Improved Outcomes in 999 Patients With Acute Pancreatitis

Lee, Peter J. MBChB1,*; Culp, Stacey PhD2,*; Kamal, Ayesha MD3; Paragomi, Pedram MD4; Pothoulakis, Ioannis MD5; Talukdar, Rupjyoti MD6; Kochhar, Rakesh MD7; Goenka, Mahesh Kumar MD8; Gulla, Aiste MD9; Gonzales, Jose MD10; Stevens, Tyler MD11; Barbu, Sorin MD12; Nawaz, Haq MD13; Gutierrez, Silvia MD14; Zarnescu, Narcis MD15; Capurso, Gabriele MD16; Easler, Jeff MD17; Triantafyllou, Konstantinos MD18; Ocampo, Carlos MD19; de-Madaria, Enrique MD20; Wu, Bechien MD21; Hart, Phil A. MD1; Akshintala, Venkata S. MD9; Singh, Vikesh K. MD9; Bischof, Jason MD1; Buxbaum, James MD22; Pelaez, Mario MD23; Papachristou, Georgios I. MD, PhD1

Author Information

1Division of Gastroenterology, Hepatology and Nutrition, Ohio State University, Columbus, Ohio, USA;

2Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, USA;

3Division of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA;

4University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;

5MedStar Washington Hospital Center, Washington, District of Columbia, USA;

6Asian Institute of Gastroenterology, Hyderabad, Telangana, India;

7Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India;

8Apollo Gleneagles Hospitals Kolkata, Kolkata, India;

9Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA;

10Universidad Autónoma de Nueva León, Monterrey, Mexico;

11Division of Gastroenterology, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio, USA;

12University of Medicine and Pharmacy “Iuliu Hatieganu,” Cluj-Napoca, Romania;

13Eastern Maine Medical Center, Bangor, Maine, USA;

14Hospital Nacional “Profesor Alejandro Posadas”, Buenos Aires, Argentina;

15University of Medicine and Pharmacy, Bucharest, Romania;

16San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy;

17Indiana University School of Medicine, Indianapolis, Indiana, USA;

18Attikon University General Hospital, Athens, Greece;

19Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina;

20Investigación Sanitaria y Biomédica de Alicante (ISABIAL—Fundación FISABIO), Alicante, Spain;

21Kaiser Permanente, Oakland, California, USA;

22University of Southern California, Los Angeles, California, USA;

23Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico.

Correspondence: Georgios I. Papachristou, MD, PhD. E-mail: [email protected].

*Peter J. Lee and Stacey Culp contributed equally to this article.

The American Journal of Gastroenterology ():10.14309/ajg.0000000000002391, July 20, 2023. | DOI: 10.14309/ajg.0000000000002391

Abstract

INTRODUCTION: 

Recent pilot trials in acute pancreatitis (AP) found that lactated ringers (LR) usage may result in decreased risk of moderately severe/severe AP compared with normal saline, but their small sample sizes limit statistical power. We investigated whether LR usage is associated with improved outcomes in AP in an international multicenter prospective study.

METHODS: 

Patients directly admitted with the diagnosis of AP were prospectively enrolled at 22 international sites between 2015 and 2018. Demographics, fluid administration, and AP severity data were collected in a standardized prospective manner to examine the association between LR and AP severity outcomes. Mixed-effects logistic regression analysis was performed to determine the direction and magnitude of the relationship between the type of fluid administered during the first 24 hours and the development of moderately severe/severe AP.

RESULTS: 

Data from 999 patients were analyzed (mean age 51 years, female 52%, moderately severe/severe AP 24%). Usage of LR during the first 24 hours was associated with reduced odds of moderately severe/severe AP (adjusted odds ratio 0.52; P = 0.014) compared with normal saline after adjusting for region of enrollment, etiology, body mass index, and fluid volume and accounting for the variation across centers. Similar results were observed in sensitivity analyses eliminating the effects of admission organ failure, etiology, and excessive total fluid volume.

DISCUSSION: 

LR administration in the first 24 hours of hospitalization was associated with improved AP severity. A large-scale randomized clinical trial is needed to confirm these findings.

© 2023 by The American College of Gastroenterology

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