Colloids in acute pancreatitis: Microcirculatory advantage or inflammatory mirage

Table 1 Summary of key trials in fluid therapy for acute pancreatitis

Ref.	Design/n	Intervention	Primary outcome	Main finding
Myburgh et al[6], 2012	RCT (249 patients)	Moderate vs aggressive RLS	Major complications	Aggressive resuscitation increased fluid-overload events (20.5% vs 6.3%); interim analysis showed no reduction in progression to moderately severe/severe pancreatitis
Buxbaum et al[9], 2017	RCT (60 patients)	Early aggressive vs standard RLS	Clinical improvement time	Aggressive hydration hastened clinical improvement (70% vs 42% at 36 hours); no volume-overload events were reported in this cohort
Garber et al[15], 2018	RCT (41 patients)	HES + crystalloid vs crystalloid alone	Intra-abdominal hypertension	The HES group had lower IAP and earlier negative fluid balance; safety concerns for colloids persist
Yang et al[16], 2004	RCT (120 patients)	Various colloids vs crystalloids	Inflammatory response	Colloid (HES combinations) groups had more rapid reduction in inflammatory markers and IAP; renal/Long-term safety signal was heterogeneous
Costea et al[7], 2025	RCT (108 patients)	Dextran 40 + RLS vs RLS alone	CRP and SIRS at 72 hours	Lower CRP at 72 hours (median 43 mg/L vs 171 mg/L; P < 0.001) with dextran arm; no statistically significant difference in organ failure, ICU admission, or mortality (in-press data)

CRP: C-reactive protein; HES: Hydroxyethyl starch; IAP: Intra-abdominal pressure; ICU: Intensive care unit; RCT: Randomized controlled trial; RLS: Ringer’s lactate solution; SIRS: Systemic inflammatory response syndrome. Data are derived from randomized controlled trials cited in the main text.