Lactated Ringer's Versus Normal Saline in Early-Phase Acute Pancreatitis: A Comparative Study of Inflammatory Markers and Clinical Outcomes.

Background and aim Early fluid resuscitation is essential for reducing inflammation and improving outcomes in acute pancreatitis. The primary objective of this study was to compare changes in inflammatory markers, particularly C-reactive protein, between lactated Ringer's (LR) and normal saline (NS) in early acute pancreatitis. Secondary objectives included comparison of early clinical outcomes (persistent systemic inflammatory response syndrome (SIRS), ICU admission, hospital stay, complications, and mortality) and late outcomes at six months. Methodology This prospective comparative study was conducted from July 2023 to June 2025. According to hospital fluid-procedure guidelines, 164 patients who presented within 24 h of the beginning of symptoms were included and given either LR (n=82) or NS (n=82). At admission and 48-72 h later, baseline demographics, clinical characteristics, and laboratory indicators, such as hematocrit, white blood cell (WBC) count, and C-reactive protein (CRP), were documented. In-hospital mortality, length of hospital stay, intensive care unit (ICU) admission, persistence of SIRS, and systemic and local sequelae were among the early clinical outcomes that were recorded. Over a six-month period, late outcomes were assessed, including the development of pancreatic pseudocysts, necrosis-related sequelae, readmission, and death. Independent t-tests, chi-square tests, and multivariate logistic regression were among the statistical analyses performed. Results At 48-72 h, CRP was significantly lower in the LR group (68.21±24.32 mg/L) than in NS (79.54±27.12 mg/L, p=0.01), and WBC counts declined more with LR (11.08±2.98×10³/µL versus 12.76±3.15×10³/µL, p=0.002). SIRS persistence >48 h occurred in 12 LR patients (14.63%) versus 22 NS patients (26.83%, p=0.04), while mean hospital stay was shorter with LR (6.12±2.14 versus 7.46±2.68 days, p=0.001). ICU admission, complications, and in-hospital mortality were lower in LR but not statistically significant. Late outcomes showed non-significant trends favoring LR. Conclusion Lactated Ringer's solution provides superior early anti-inflammatory effects and improved clinical outcomes compared to normal saline in early acute pancreatitis. Patients receiving lactated Ringer's demonstrated greater reductions in inflammatory markers, including C-reactive protein and white blood cell counts, as well as reduced persistence of systemic inflammatory response syndrome and shorter hospital stays. Although trends toward reduced complications and mortality were observed, these did not reach statistical significance. Further large-scale randomized controlled trials are warranted to validate these findings and guide clinical practice.