Association of early crystalloid type with mortality and costs in acute pancreatitis: a nationwide cohort study.

BACKGROUND

Early intravenous crystalloid resuscitation is central to acute pancreatitis (AP) management; however, whether normal saline (NS) or balanced Ringer's solutions (RS) are superior for reducing mortality remains unsettled.

METHODS

Using the Japanese Diagnosis Procedure Combination database (July 2010-March 2022), we identified adults admitted to general medical wards with AP who had a hospital stay longer than 3 days and received sufficient fluid resuscitation within three days of admission. Patients were classified by predominant crystalloid exposure during the first three days (NS vs. RS). Propensity score matching was used to balance measured confounders and compare in-hospital mortality and total hospitalization costs between the two groups.

RESULTS

Among 43,247 eligible patients, 1,652 (4.0%) predominantly received NS and 41,595 (96.0%) predominantly received RS. Propensity score matching yielded 1,650 well-balanced pairs. In-hospital mortality was higher with NS than with RS (2.9% vs 1.8%; risk difference, 1.2%; 95% CI, 0.12% to 2.2%). NS was also associated with higher total hospitalization costs (difference, 1,344 USD; 95% CI, 725 to 1,963).

CONCLUSIONS

In this nationwide cohort of adults with AP admitted to general medical wards, predominant early use of NS was associated with higher in-hospital mortality and higher hospitalization costs compared with RS.