Dawson, A.Karunakaran, M.Sharma, Z.D.Ullah, S.Barreto, S.G.2024-08-132024-08-132023HPB, 2023; 25(12):1451-14651365-182X1477-2574https://hdl.handle.net/2440/141863Background: Third space fluid loss is one of the hallmarks of the pathophysiology of acute pancreatitis (AP) contributing to complications, including organ failure and death. We conducted a systematic review of literature to determine the ideal fluid resuscitation in the early management of AP, primarily comparing aggressive versus moderate intravenous fluid resuscitation (AIR vs MIR). Methods: A systematic review of major reference databases was undertaken. Meta-analysis was performed using random-effects model. Bias was assessed using Cochrane risk of bias and ROBINS-I tools for randomized and non-randomised studies, respectively. Results: Twenty studies were included in the analysis. Though there was no significant difference in mortality between AIR and MIR groups (8.3% versus 6.0%; p = 0.3), AIR cohort had significantly higher rates of organ failure (p = 0.009), including pulmonary (p = 0.02) and renal (p = 0.01) complications. Similarly, there was no difference in mortality between normal saline (NS) and Ringer’s lactate (RL) (3.17% versus 3.01%; p = 0.23), though patients treated with NS had a significantly longer length of hospital stay (LOS) (p = 0.009). Conclusions: Current evidence appears to support moderate intravenous resuscitation (level of evidence, low) with RL (level of evidence, moderate) in the early management of AP.enCrown Copyright © 2023 Published by Elsevier Ltd on behalf of International Hepato-Pancreato-Biliary Association Inc. All rights reserved.acute pancreatitisHumansPancreatitisAcute DiseaseIsotonic SolutionsFluid TherapyRinger's LactateJournal article10.1016/j.hpb.2023.08.0132024-08-12657086Ullah, S. [0000-0002-1825-7774] [0000-0003-0010-2640]