Safety And Efficacy Of Balanced Crystlloids Verus Normal Saline For Fluid Resuscitation In Adult Patients With Sepsis: A Meta-anlysis

Background and objective: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection.The overall mortality rate of sepsis ranges from 20 to 40% and remains a major challenge for healthcare systems worldwide.Rapid and accurate diagnosis and early development of targeted treatment strategies are prerequisites for reducing morbidity and mortality.Fluid resuscitation is one of the main treatment for sepsis and septic shock,and the different types of crystalloids in initial fluid resuscitation may have an impact on clinical outcomes.The purpose of this meta-analysis was to compare the effects of balnced crystlloids and normal saline in fluid resuscitation of septic patients and to evaluate whether they can reduce in-hospital mortality of sepsis,incidence of AKI,and new RRT use.Methods: The databases were searched electronically by computer,including Cochranelibrary,EMBASE,Pub Med,Webof Science,Wanfang database,and China National Knowledge Infrastructure(CNKI).Studies comparing balnced crystlloids and normal saline in the treatment of sepsis or septic shock were collected.Search scope self-built library until January 2021.Two independent researchers initially searched and read the relevant literature by searching a combination of subject headings and free words,screened,extracted,and evaluated the included studies according to the criteria.Meta-analysis data results were processed using Revman 5.3 software.Results: A total of 790 literatures were retrieved,286 literatures were deweighted,and 9 studies were included in this meta-analysis,involving 11,378 patients,all of which met the diagnosis of adult sepsis or septic shock,excluding the literatures that did not meet the inclusion criteria.Clinical outcome measures of in-hospital mortality,incidence of AKI,and use of new RRT were counted in different studies,respectively.The results of this meta-analysis showed that balnced crystlloids reduced in-hospital mortality(RR=0.85,95%CI=0.79,0.92,P<0.0001),AKI incidence(RR=0.84,95%CI=0.78,0.91,P<0.0001),and did not reduce the use of new RRT(RR=0.79,95%CI=0.58,1.09,P=0.15)compared with saline.Conclusions: The available evidence suggests that the choice of balnced crystlloids as the crystalloid of choice for resuscitation in the initial fluid resuscitation of patients with sepsis or septic shock reduces in-hospital mortality,the incidence of AKI,but not the use of new RRT compared with saline.However,limited by the number and quality of included studies as well as the limitations of different fluid resuscitation protocols,further multicenter,double-blind,randomized controlled large-scale trials are needed for validation.