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Randomized Controlled Trial
. 2024 Feb;78(2):360-368.
doi: 10.1002/jpn3.12082. Epub 2023 Dec 11.

Faster discharge with lactated ringers than normal saline in first 72 h of acute pancreatitis: A multicenter randomized trial

Peter R Farrell  1   2 , Angelica W DesPain  3 , Peter Farmer  4 , Leslie M Farrell  1   5 , Bryan Greenfield  6   7 , Michael E Rogers  1   2 , Lindsey Hornung  8 , Esther Kim  9 , Ryan Pearman  10 , Beemnet Neway  11 , Tyler Thompson  2 , James E Heubi  1   2 , Sona Sehgal  12 , Rana Amoury  13   14 , Maisam Abu-El-Haija  1   2
Affiliations
Randomized Controlled Trial

Faster discharge with lactated ringers than normal saline in first 72 h of acute pancreatitis: A multicenter randomized trial

Peter R Farrell et al. J Pediatr Gastroenterol Nutr. 2024 Feb.

Abstract

Objectives: Data driven strategies for acute pancreatitis (AP) in pediatrics are limited; adult data suggests lactated ringers (LR) compared to normal saline (NS) resulted in favorable outcomes, but has not been studied in pediatrics. Our objective was to evaluate the efficacy of LR during the first 48 h of an AP episode compared with NS.

Study design: A multisite randomized controlled clinical trial, from 2015 to 2020 (Clinical Trials.gov NCT03242473). Patients were randomized to exclusively LR or NS for the first 48 h. Primary outcomes were serial C-reactive protein (CRP) values. Secondary outcomes included other lab values, time to feeds, length of stay (LOS), systemic inflammatory response syndrome (SIRS) development, and progression to severe AP (SAP).

Results: We studied 76 patients (38 LR, 38 NS). CRP at 24 and 48 h were not significantly different between LR or NS group. Additionally, there were no differences in trends of BUN, amylase, lipase, SIRS status, or SAP development between the LR and NS group at 24 and 48 h. A higher proportion of LR patients (32%, 12/38) were discharged before 48 h compared to NS (13%, 5/38). The LR group had a significantly higher rate of discharge within the first 72 h compared to the NS group (p = 0.02).

Conclusion: The use of LR was associated with a faster rate of discharge during the intervention period and in the first 72 h, but no other differences compared to NS. This reduction in length of hospitalization has significant implications for patients and healthcare costs.

Keywords: acute pancreatitis; lactated ringers; normal saline; pediatrics.

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Figures

Figure 1
Figure 1
a: Overall Length of Stay in both cohorts. Figure 1b: Proportion of patients still hospitalized after the first 72 hours between the two treatment arms. LR shows a – 0.21 interaction coefficient compared to NS (for every LOS hour increase the proportion of patients still hospitalized in the LR group decreases by 0.21 compared to the NS group)
See this image and copyright information in PMC

References

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