Meta-analysis shows lactated ringer's may shorten hospital stay but offers no mortality benefit in acute pancreatitis

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Frontiers in Medicine Published May 9, 2026 Medically reviewed May 9, 2026 Study authors: Weijun Jiang, Jingwen Peng, Qiuyue Wu, Shengjie Wang, Peng Zheng, Xinyi Xia DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider that lactated ringer's shortens hospital stay but offers no mortality benefit in acute pancreatitis.

This systematic review and meta-analysis examined fluid resuscitation strategies for patients with acute pancreatitis. The study compared lactated ringer's (LR) against normal saline (NS) as the primary intervention. The primary outcomes included mortality, systemic inflammatory response syndrome, ICU transfer, pancreatic necrosis, organ failure, and hospital length of stay. The sample size was not reported, and the setting was not reported.

Regarding overall mortality, the analysis found no difference between LR and NS. The odds ratio was 1.020 with a 95% CI of 0.865–1.359 and a p value of 0.895. For mortality in severe acute pancreatitis, no mortality benefit for LR was observed. The odds ratio was 0.931 with a 95% CI of 0.157–5.505 and a p value of 0.937.

In randomized controlled trials, LR significantly shortened hospital length of stay. The standardized mean difference was -0.307 with a 95% CI of -0.511 to -0.102 and a p value of 0.003. In small-sample studies involving 100 cases, LR also significantly shortened length of stay. Safety profiles were comparable between the two fluids. However, the study had insufficient power for pancreatic necrosis, organ failure, and length of stay. Trial sequential analysis confirmed true negative findings for mortality, ICU transfer, and SIRS but indicated insufficient power for other outcomes. The association with prolonged LOS in patients with SAP requires further validation.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Intravenous fluid resuscitation is fundamental in acute pancreatitis (AP), but optimal crystalloid selection remains debated. This meta-analysis compares lactated ringer’s (LR) and normal saline (NS) for outcomes in AP. We conducted the systematic review and meta-analysis in accordance with the PRISMA 2020 guidelines. We systematically searched PubMed, Web of Science, Embase, CNKI, and WanFang (Until July 2025) for studies comparing LR and NS in AP. Primary outcomes included mortality, systemic inflammatory response syndrome (SIRS), ICU transfer, pancreatic necrosis, organ failure, and hospital length of stay (LOS). Random- or fixed-effects models were used based on heterogeneity (I2). Overall mortality did not differ between LR and NS (OR = 1.020, 95% CI: 0.865–1.359, p = 0.895). No mortality benefit was observed for LR in any severity subgroup, including severe acute pancreatitis (SAP) (OR = 0.931, 95% CI: 0.157–5.505, p = 0.937). LR significantly shortened LOS in RCTs (SMD = −0.307, 95% CI: −0.511 to −0.102, p = 0.003) and small-sample studies (100 cases) subgroups. Trial sequential analysis confirmed true negative findings for mortality, ICU transfer and SIRS, but indicated insufficient power for pancreatic necrosis, organ failure and LOS. LR and NS demonstrate comparable mortality and safety profiles, with no significant difference in overall LOS. Although LR may shorten LOS in certain subgroups, its association with prolonged LOS in patients with SAP requires further validation. Therefore, based on current evidence, no preference can be recommended for either fluid, and larger standardized trials are warranted.