Balanced Crystalloids versus Saline in Sepsis A Secondary Analysis of the SMART Clinical Trial
Balanced Crystalloids versus Saline in Sepsis A Secondary Analysis of the SMART Clinical Trial
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DOI：
10.1164/rccm.201903-0557oc
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发表时间：
2019-12-15
影响因子：
24.7
通讯作者：
Semler, Matthew W.
中科院分区：
文献类型：
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作者：
Brown, Ryan M.;Wang, Li;Semler, Matthew W.
理论基础：静脉注射晶体溶液是脓毒症的基本治疗方法，但晶体成分对患者预后的影响尚不清楚。目的：比较平衡晶体溶液和生理盐水对重症成人脓毒症患者30天住院死亡率的影响。方法：根据国际疾病分类第10版，对内科ICU收治的SMART(等渗液和主要不良肾事件试验)患者进行二次分析，使用多变量回归控制潜在的混杂因素。测量和主要结果：在SMART注册的15,802名患者中，1,641名被诊断为败血症的患者进入内科ICU。平衡结晶组共有217名患者(26.3%)经历了30天的住院死亡率，而生理盐水组有255名患者(31.2%)经历了住院死亡(调整后的优势比[AOR]为0.74；95%可信区间[CI]为0.59-0.93；P=0.01)。平衡组患者在30天内的主要不良肾脏事件发生率较低(35.4%比40.1%；AOR，0.78；95%CI，0.63-0.97)，更多的无血管加压剂天数(20+/-12vs.19+/-13；AOR，1.25；95%CI，1.02-1.54)和肾脏替代治疗无天数(20+/-12vs.19+/-13；AOR，1.35；结论：在一项大型随机试验中，在脓毒症患者中，使用平衡晶体与使用生理盐水相比，30天的住院死亡率较低。
Rationale: Administration of intravenous crystalloid solutions is a fundamental therapy for sepsis, but the effect of crystalloid composition on patient outcomes remains unknown.Objectives: To compare the effect of balanced crystalloids versus saline on 30-day in-hospital mortality among critically ill adults with sepsis.Methods: Secondary analysis of patients from SMART (Isotonic Solutions and Major Adverse Renal Events Trial) admitted to the medical ICU with an International Classification of Diseases, 10th Edition, Clinical Modification System code for sepsis, using multivariable regression to control for potential confounders.Measurements and Main Results: Of 15,802 patients enrolled in SMART, 1,641 patients were admitted to the medical ICU with a diagnosis of sepsis. A total of 217 patients (26.3%) in the balanced crystalloids group experienced 30-day in-hospital morality compared with 255 patients (31.2%) in the saline group (adjusted odds ratio [aOR], 0.74; 95% confidence interval [CI], 0.59-0.93; P = 0.01). Patients in the balanced group experienced a lower incidence of major adverse kidney events within 30 days (35.4% vs. 40.1%; aOR, 0.78; 95% CI, 0.63-0.97) and a greater number of vasopressor-free days (20 +/- 12 vs. 19 +/- 13; aOR, 1.25; 95% CI, 1.02-1.54) and renal replacement therapy-free days (20 +/- 12 vs. 19 +/- 13; aOR, 1.35; 95% CI, 1.08-1.69) compared with the saline group.Conclusions: Among patients with sepsis in a large randomized trial, use of balanced crystalloids was associated with a lower 30-day in-hospital mortality compared with use of saline.