3 Comparison of Normal Saline and Plasmalyte in the Management of Acute Pancreatitis

Abstract

INTRODUCTION: Acute pancreatitis (AP) is one of the most common causes of hospitalization in the United States. Intravenous (IV) hydration with normal saline (NS) is the most commonly used fluid for resuscitation. Recent studies have shown better outcomes with use of more pH balanced fluid like ringer's lactate and Plasmalyte (PL). We conducted a retrospective review to evaluate differences in outcomes of AP in patients who received NS compared to PL. METHODS: All patients >18 years of age admitted to our hospital with the diagnosis of AP from November 2016 to October 2018. Primary outcomes were persistent SIRS at 48 hours and mortality. Secondary outcomes were readmission within 30 days and length of stay (LOS). Categorical characteristics of NS and PL patients were compared using Pearson's chi-square or Fisher's exact tests and continuous ones were compared using Student's t-tests or Wilcoxon rank-sum tests. Odds ratios (OR) and their 95% confidence intervals (CI) were estimated using a multivariable logistic regression model for 30 days readmission. The model adjusted for age, sex, SIRS at 48 hours, and LOS. A multivariable linear regression model on a natural log transformation of LOS was used to estimate the effect of fluid type on LOS for NS and PL patients. Statistical analysis was conducted using SAS 9.4. RESULTS: 343 patients met our inclusion criteria. 192 patients received NS and 151 received PL for IV hydration. There were no differences in the baseline demographics including age, sex, BMI and comorbidities as calculated by Charlson comorbidity index. Persistent SIRS at 48 hours was significantly higher in patients who received NS compared to PL (26.8% vs 7.7%; P = <0.0001). LOS was significantly higher in patients who received NS (4.7 days vs 3.7 days, P = 0.0039). 30 days readmission was also significantly higher in NS group (22.8% vs 12.8%; P = 0.0195). Mortality although trended lower in PL group, was not significantly different (7.3% NS group vs 2.6% PL group, P = 0.0556). In multivariable analysis use of PL is associated with lower odds of 30 days readmission [OR = 0.515 (CI: 0.280–0.950); P = 0.0338] and shorter LOS [%decrease = 16.6% (CI: −26.4%, −5.5%); P = 0.0045]. CONCLUSION: Our study revealed that use of PL in AP is associated with lower rate of persistent SIRS at 48 hours, shorter LOS, and 30 days readmission rate. Larger randomized controlled trials are needed to further strengthen the association of PL for outcomes in AP.