S211 Lactated Ringer's Reduces ICU Transfer and Organ Failure in Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Early moderately aggressive intravenous hydration is key in the early management of patients with acute pancreatitis. Normal saline’s (NS) acidic pH, supraphysiologic chloride load may worsen metabolic acidosis, renal perfusion, and systemic inflammation, whereas balanced lactated ringer’s (LR) could mitigate organ injury. While there are theoretical benefits to using LR, few clinical trials have been performed to conclusively support the current recommendation in the ACG Guidelines. Whether these biochemical advantages translate into tangible bedside benefits has not been fully resolved. To address this gap, we analyzed all available randomized trials comparing LR with NS in adults hospitalized for acute pancreatitis, focusing on clinically meaningful outcomes such as ICU transfer, hospital stay, persistent organ failure, SIRS, and mortality. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified randomized controlled trials comparing LR and NS for treatment of acute pancreatitis through May 2025. Data were analyzed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at P < 0.05. Risk of bias was assessed using RoB 2.0. Results: In 3 randomized controlled trials (de-Madaria 2018, Wu 2011, Ke 2025) of 339 adults with acute pancreatitis, balanced crystalloids (n = 150) vs NS (n = 189) reduced: ICU transfers from 56% to 47% (RR 0.88, 95% CI 0.73–1.05; I² = 0%); persistent organ failure from 43% to 37% (RR 0.89, 95% CI 0.69–1.13; I² = 0%); post-resuscitation SIRS from 50% to 41% (RR 0.82, 95% CI 0.63–1.06; I² = 38%); and in-hospital mortality from 3 deaths to none (RR 0.30, 95% CI 0.03–2.69). Heterogeneity was negligible for ICU transfer and organ failure, and no fluid-related adverse events occurred, suggesting clinically meaningful benefit of chloride-restricted fluids. Conclusion: LR consistently trended toward fewer ICU transfers, organ failures, post-resuscitation SIRS episodes, and in-hospital deaths relative to saline, without added harm. Although the pooled risk reductions did not yet reach conventional significance thresholds, the uniform direction of benefit, low heterogeneity, and absence of adverse events together signal that LR may offer a clinically relevant advantage. These findings support preferential use of LR during initial resuscitation.