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Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis*.

Publication ,  Journal Article
Raghunathan, K; Shaw, A; Nathanson, B; Stürmer, T; Brookhart, A; Stefan, MS; Setoguchi, S; Beadles, C; Lindenauer, PK
Published in: Crit Care Med
July 2014

OBJECTIVE: Isotonic saline is the most commonly used crystalloid in the ICU, but recent evidence suggests that balanced fluids like Lactated Ringer's solution may be preferable. We examined the association between choice of crystalloids and in-hospital mortality during the resuscitation of critically ill adults with sepsis. DESIGN: A retrospective cohort study of patients admitted with sepsis, not undergoing any surgical procedures, and treated in an ICU by hospital day 2. We used propensity score matching to control for confounding and compared the following outcomes after resuscitation with balanced versus with no-balanced fluids: in-hospital mortality, acute renal failure with and without dialysis, and hospital and ICU lengths of stay. We also estimated the dose-response relationship between receipt of increasing proportions of balanced fluids and in-hospital mortality. SETTING: Three hundred sixty U.S. hospitals that were members of the Premier Healthcare alliance between November 2005 and December 2010. PATIENTS: A total of 53,448 patients with sepsis, treated with vasopressors and crystalloids in an ICU by hospital day 2 including 3,396 (6.4%) that received balanced fluids. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients treated with balanced fluids were younger and less likely to have heart or chronic renal failure, but they were more likely to receive mechanical ventilation, invasive monitoring, colloids, steroids, and larger crystalloid volumes (median 7 vs 5 L). Among 6,730 patients in a propensity-matched cohort, receipt of balanced fluids was associated with lower in-hospital mortality (19.6% vs 22.8%; relative risk, 0.86; 95% CI, 0.78, 0.94). Mortality was progressively lower among patients receiving larger proportions of balanced fluids. There were no significant differences in the prevalence of acute renal failure (with and without dialysis) or in-hospital and ICU lengths of stay. CONCLUSIONS: Among critically ill adults with sepsis, resuscitation with balanced fluids was associated with a lower risk of in-hospital mortality. If confirmed in randomized trials, this finding could have significant public health implications, as crystalloid resuscitation is nearly universal in sepsis.

Duke Scholars

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Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

July 2014

Volume

42

Issue

7

Start / End Page

1585 / 1591

Location

United States

Related Subject Headings

  • Sepsis
  • Ringer's Lactate
  • Retrospective Studies
  • Resuscitation
  • Respiration, Artificial
  • Rehydration Solutions
  • Propensity Score
  • Length of Stay
  • Isotonic Solutions
  • Humans
 

Citation

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Raghunathan, K., Shaw, A., Nathanson, B., Stürmer, T., Brookhart, A., Stefan, M. S., … Lindenauer, P. K. (2014). Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis*. Crit Care Med, 42(7), 1585–1591. https://doi.org/10.1097/CCM.0000000000000305
Raghunathan, Karthik, Andrew Shaw, Brian Nathanson, Til Stürmer, Alan Brookhart, Mihaela S. Stefan, Soko Setoguchi, Chris Beadles, and Peter K. Lindenauer. “Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis*.Crit Care Med 42, no. 7 (July 2014): 1585–91. https://doi.org/10.1097/CCM.0000000000000305.
Raghunathan K, Shaw A, Nathanson B, Stürmer T, Brookhart A, Stefan MS, et al. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis*. Crit Care Med. 2014 Jul;42(7):1585–91.
Raghunathan, Karthik, et al. “Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis*.Crit Care Med, vol. 42, no. 7, July 2014, pp. 1585–91. Pubmed, doi:10.1097/CCM.0000000000000305.
Raghunathan K, Shaw A, Nathanson B, Stürmer T, Brookhart A, Stefan MS, Setoguchi S, Beadles C, Lindenauer PK. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis*. Crit Care Med. 2014 Jul;42(7):1585–1591.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

July 2014

Volume

42

Issue

7

Start / End Page

1585 / 1591

Location

United States

Related Subject Headings

  • Sepsis
  • Ringer's Lactate
  • Retrospective Studies
  • Resuscitation
  • Respiration, Artificial
  • Rehydration Solutions
  • Propensity Score
  • Length of Stay
  • Isotonic Solutions
  • Humans