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Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis

The crystalloid fluid of choice in sepsis remains debatable. We aimed to perform a comprehensive meta-analysis to compare the effect of balanced crystalloids (BC) vs. normal saline (NS) in adults with sepsis. A systematic search of PubMed, EMBASE, and Web of Sciences databases through 22 January 202...

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Autores principales: Beran, Azizullah, Altorok, Nehaya, Srour, Omar, Malhas, Saif-Eddin, Khokher, Waleed, Mhanna, Mohammed, Ayesh, Hazem, Aladamat, Nameer, Abuhelwa, Ziad, Srour, Khaled, Mahmood, Asif, Altorok, Nezam, Taleb, Mohammad, Assaly, Ragheb
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8999853/
https://www.ncbi.nlm.nih.gov/pubmed/35407578
http://dx.doi.org/10.3390/jcm11071971
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author Beran, Azizullah
Altorok, Nehaya
Srour, Omar
Malhas, Saif-Eddin
Khokher, Waleed
Mhanna, Mohammed
Ayesh, Hazem
Aladamat, Nameer
Abuhelwa, Ziad
Srour, Khaled
Mahmood, Asif
Altorok, Nezam
Taleb, Mohammad
Assaly, Ragheb
author_facet Beran, Azizullah
Altorok, Nehaya
Srour, Omar
Malhas, Saif-Eddin
Khokher, Waleed
Mhanna, Mohammed
Ayesh, Hazem
Aladamat, Nameer
Abuhelwa, Ziad
Srour, Khaled
Mahmood, Asif
Altorok, Nezam
Taleb, Mohammad
Assaly, Ragheb
author_sort Beran, Azizullah
collection PubMed
description The crystalloid fluid of choice in sepsis remains debatable. We aimed to perform a comprehensive meta-analysis to compare the effect of balanced crystalloids (BC) vs. normal saline (NS) in adults with sepsis. A systematic search of PubMed, EMBASE, and Web of Sciences databases through 22 January 2022, was performed for studies that compared BC vs. NS in adults with sepsis. Our outcomes included mortality and acute kidney injury (AKI), need for renal replacement therapy (RRT), and ICU length of stay (LOS). Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) were obtained using a random-effect model. Fifteen studies involving 20,329 patients were included. Overall, BC showed a significant reduction in the overall mortality (RR 0.88, 95% CI 0.81–0.96), 28/30-day mortality (RR 0.87, 95% CI 0.79–0.95), and AKI (RR 0.85, 95% CI 0.77–0.93) but similar 90-day mortality (RR 0.96, 95% CI 0.90–1.03), need for RRT (RR 0.91, 95% CI 0.76–1.08), and ICU LOS (MD −0.25 days, 95% CI −3.44, 2.95), were observed between the two groups. However, subgroup analysis of randomized controlled trials (RCTs) showed no statistically significant differences in overall mortality (RR 0.92, 95% CI 0.82–1.02), AKI (RR 0.71, 95% CI 0.47–1.06), and need for RRT (RR 0.71, 95% CI 0.36–1.41). Our meta-analysis demonstrates that overall BC was associated with reduced mortality and AKI in sepsis compared to NS among patients with sepsis. However, subgroup analysis of RCTs showed no significant differences in both overall mortality and AKI between the groups. There was no significant difference in the need for RRT or ICU LOS between BC and NS. Pending further data, our study supports using BC over NS for fluid resuscitation in adults with sepsis. Further large-scale RCTs are necessary to validate our findings.
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spelling pubmed-89998532022-04-12 Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis Beran, Azizullah Altorok, Nehaya Srour, Omar Malhas, Saif-Eddin Khokher, Waleed Mhanna, Mohammed Ayesh, Hazem Aladamat, Nameer Abuhelwa, Ziad Srour, Khaled Mahmood, Asif Altorok, Nezam Taleb, Mohammad Assaly, Ragheb J Clin Med Review The crystalloid fluid of choice in sepsis remains debatable. We aimed to perform a comprehensive meta-analysis to compare the effect of balanced crystalloids (BC) vs. normal saline (NS) in adults with sepsis. A systematic search of PubMed, EMBASE, and Web of Sciences databases through 22 January 2022, was performed for studies that compared BC vs. NS in adults with sepsis. Our outcomes included mortality and acute kidney injury (AKI), need for renal replacement therapy (RRT), and ICU length of stay (LOS). Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) were obtained using a random-effect model. Fifteen studies involving 20,329 patients were included. Overall, BC showed a significant reduction in the overall mortality (RR 0.88, 95% CI 0.81–0.96), 28/30-day mortality (RR 0.87, 95% CI 0.79–0.95), and AKI (RR 0.85, 95% CI 0.77–0.93) but similar 90-day mortality (RR 0.96, 95% CI 0.90–1.03), need for RRT (RR 0.91, 95% CI 0.76–1.08), and ICU LOS (MD −0.25 days, 95% CI −3.44, 2.95), were observed between the two groups. However, subgroup analysis of randomized controlled trials (RCTs) showed no statistically significant differences in overall mortality (RR 0.92, 95% CI 0.82–1.02), AKI (RR 0.71, 95% CI 0.47–1.06), and need for RRT (RR 0.71, 95% CI 0.36–1.41). Our meta-analysis demonstrates that overall BC was associated with reduced mortality and AKI in sepsis compared to NS among patients with sepsis. However, subgroup analysis of RCTs showed no significant differences in both overall mortality and AKI between the groups. There was no significant difference in the need for RRT or ICU LOS between BC and NS. Pending further data, our study supports using BC over NS for fluid resuscitation in adults with sepsis. Further large-scale RCTs are necessary to validate our findings. MDPI 2022-04-01 /pmc/articles/PMC8999853/ /pubmed/35407578 http://dx.doi.org/10.3390/jcm11071971 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Beran, Azizullah
Altorok, Nehaya
Srour, Omar
Malhas, Saif-Eddin
Khokher, Waleed
Mhanna, Mohammed
Ayesh, Hazem
Aladamat, Nameer
Abuhelwa, Ziad
Srour, Khaled
Mahmood, Asif
Altorok, Nezam
Taleb, Mohammad
Assaly, Ragheb
Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis
title Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis
title_full Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis
title_fullStr Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis
title_full_unstemmed Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis
title_short Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis
title_sort balanced crystalloids versus normal saline in adults with sepsis: a comprehensive systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8999853/
https://www.ncbi.nlm.nih.gov/pubmed/35407578
http://dx.doi.org/10.3390/jcm11071971
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