Balanced Crystalloids versus Saline in Sepsis. A Secondary Analysis of the SMART Clinical Trial
Open accessAbstract
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 crys…
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Source control of infectious foci was associated with improved survival in recent observational and cluster randomized studies.
“Source control of infectious foci was associated with improved survival in recent observational and cluster randomized studies (120,263,264).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [264]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
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- Authors
- Brown, R. M., Wang, L., Coston, T. D., Krishnan, N. I., Casey, J. D., Wanderer, J. P., Ehrenfeld, J. M., Byrne, D. W., Stollings, J. L., Siew, E. D., Bernard, G. R., Self, W. H., Rice, T. W., & Semler, M. W.
- Affiliations
- Division of Allergy, Pulmonary, and Critical Care Medicine
- Department of Biostatistics
- Department of Medicine
- Department of Anesthesiology
- Department of Pharmaceutical Services
- Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Division of Nephrology and Hypertension, and
- Vanderbilt University Medical Center (US)
- Corresponding author
- Semler, Matthew W.
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-12
- Volume
- 200
- Issue
- 12
- Pages
- 1487-1495
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- PMC
- PMC6909845
- OpenAlex
- W2970682829
- Cited by
- 202
- References
- 4
- Citations by year
- 2026: 19 · 2025: 27 · 2024: 32 · 2023: 33 · 2022: 34 · 2021: 37 · 2020: 19 · 2019: 1
- FWCI
- 17.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- NHLBI (HL087738-09, K12HL133117, K23HL143053)
- NIH (R34HL105869)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- sepsis, balanced crystalloids, saline, intravenous fluid therapy, 30-day in-hospital mortality, major adverse kidney events, vasopressor-free days, renal replacement therapy, SMART trial, critically ill adults, medical ICU
- MeSH terms
- Crystalloid Solutions, Adult, Aged, Critical Care, Female, Hospitalization, Humans, Male, Middle Aged, Treatment Outcome, Hospital Mortality, Cross-Over Studies, Sepsis
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