Normal Saline Solution or Lactated Ringer’s Solution to Enhance Lactate Clearance in Septic Patients After Initial Resuscitation in the ED: A Retrospective Cohort Trial

Figures & data

Table 1 Baseline Characteristics of the Patients

Characteristics	NSS	LRS	P-value
	(100 Patients)	(20 Patients)
Age, year, median (IQR)	68 (57, 82.2)	69 (59.8, 80)	0.797
Male	64 (64)	11 (55)	0.613
NEWS score, median (IQR)	10 (8, 12)	9 (7, 10.2)	0.162
Mechanical ventilation	33 (33)	5 (25)	0.661
Comorbidity
Diabetes mellitus	35 (35)	5 (25)	0.544
Cirrhosis	10 (10)	0 (0)	0.210
Hematologic malignancy	4 (4)	0 (0)	1.000
Autoimmune disease	3 (3)	0 (0)	1.000
Malignancy with chemotherapy within 1 month	13 (13)	5 (25)	0.180
HIV infection	2 (2)	0 (0)	1.000
Medication used
Vasopressor	34 (34)	6 (30)	0.931
Systemic steroid	17 (17)	2 (10)	0.737
Immunosuppressive agent	8 (8)	0 (0)	0.349
Bronchodilator (b2-agonist)	17 (17)	1 (5)	0.302
Initial kidney function
Serum creatinine, median (IQR)	1.1 (0.8, 1.7)	1 (0.7, 1.2)	0.263
Chronic kidney disease			0.745
Stage 1	31 (31)	7 (35)
Stage 2	23 (23)	7 (35)
Stage 3	31 (31)	5 (25)
Stage 4	12 (12)	1 (5)
Stage 5	3 (3)	0 (0)
Total amount of fluid, mL, median (IQR)	1000 (600, 1525)	750 (500, 1600)	0.210

Notes: Data are presented as n (%) unless indicated otherwise. Values <0.05 are statistically significant. The means of crystalloid volume in both groups were 1000 (600, 1600) mL (P=0.21).

Abbreviations: NSS, normal saline solution; LRS, lactated Ringer’s solution; IQR, interquartile range; HIV, human immunodeficiency virus.

Figure 1 Consort flow diagram of trial.

Notes: Adapted from: Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials. PLoS Med. 2010;7(3):e1000251.²² Copyright: © 2010 Schulz et al. Creative Commons Attribution License.

Table 2 Comparison of Isotonic Crystalloid Fluids in Septic Patients in the Emergency Department

Variables	NSS	LRS	P-value
	(100 Patients)	(20 Patients)
Initial lactate, mmol/L, median (IQR)	3.6 (2.6, 4.9)	3 (2.4, 3.9)	0.219
Serum lactate level within 2 h, median (IQR)	2.9 (1.6, 3.8)	2 (1.7, 2.3)	0.187
Serum lactate level within 4 h, median (IQR)	3.1 (1.8, 4.3)	2.5 (1.7, 4.7)	0.802
Serum lactate changed within 2 h, median (IQR)	−25 (−52.2, −9.1)	−29.2 (−48.2, −13.8)	0.839
Serum lactate changed within 4 h, median (IQR)	−27.1 (−51.5, −8)	−0.8 (−34.8, 19.4)	0.515
Lactate trend change, decrease	83 (83)	15 (75)	0.526
Serum creatinine level within 24 h, mean (SD)**	1.4 (0.9)	1.1 (0.7)	0.226
Serum creatinine changed within 24 h, mean (SD)**	0.3 (0.5)	0.3 (0.3)	0.838
48-h survival rate	86 (86)	18 (90)	1.000

Notes: Data are presented as n (%) unless indicated otherwise. Values <0.05 are statistically significant. **Data is non-normal distribution but presented with mean because it was analyzed to fit to the generalized estimating equations.

Abbreviations: NSS, normal saline solution; LRS, lactated Ringer’s solution; IQR, interquartile range; SD, standard deviation.

Figure 2 Percentage of serum lactate change after intravenous fluid resuscitation in septic patients.

Figure 3 Serum creatinine level after fluid resuscitation in septic patients. *P<0.05.

Table 3 Comparison of the Increased and Decreased Lactate Groups

Variables	Decreased	Increased	P-value
	(98 Patients)	(22 Patients)
Age, year, median (IQR)	67.5 (56, 80.8)	80 (65, 85.8)	0.032
Male	61 (62.2)	14 (63.6)	1.000
Weight, kg, median (IQR)	54.2 (50, 65.2)	55 (41, 60)	0.151
NEWS score, median (IQR)	9 (7, 12)	10 (9, 11.8)	0.244
Oxygen support	60 (61.2)	14 (63.6)	1.000
Initial SpO2, %, median (IQR)	94 (88.2, 97.8)	91 (86.5, 96)	0.212
Mechanical ventilation	28 (28.6)	10 (45.5)	0.199
Comorbidity
Diabetes mellitus	34 (34.7)	6 (27.3)	0.677
Cirrhosis	6 (6.1)	4 (18.2)	0.084
Hematologic malignancy	3 (3.1)	1 (4.5)	0.560
Autoimmune disease	2 (2)	1 (4.5)	0.458
Malignancy with chemotherapy within 1 month	15 (15.3)	3 (13.6)	1.000
HIV infection	2 (2)	0 (0)	1.000
Medication used
Vasopressor	28 (28.6)	12 (54.5)	0.037
Systemic Steroid	16 (16.3)	3 (13.6)	1.000
Immunosuppressive agent	4 (4.1)	4 (18.2)	0.037
Bronchodilator (β2-agonist)	12 (12.2)	6 (27.3)	0.097
Initial kidney function
Serum creatinine, median (IQR)	1 (0.8, 1.4)	1.4 (1, 2.2)	0.030
Chronic kidney disease			0.177
Stage 1	34 (34.7)	4 (18.2)
Stage 2	25 (25.5)	5 (22.7)
Stage 3	29 (29.6)	7 (31.8)
Stage 4	8 (8.2)	5 (22.7)
Stage 5	2 (2)	1 (4.5)
Total amount of fluid, mL, median (IQR)	1000 (565, 1500)	1500 (850, 1687.5)	0.065

Notes: Data are presented as n (%) unless indicated otherwise. Values <0.05 are statistically significant.

Abbreviation: IQR, interquartile range.

Table 4 Multivariate Analysis by Logistic Regression; if Isotonic Crystalloid Solution Results in Increasing versus Decreasing Serum Lactate Levels

Variables	Crude OR (95% Cl)	Adjusted OR (95% CI)	P-value
Age	1.03 (1, 1.06)	1.04 (1.01, 1.08)	0.010
Vasopressor used	3 (1.16, 7.73)	3.4 (1.24, 9.39)	0.017
Immunosuppressive agents used	5.22 (1.19,22.82)	10.19 (1.79, 57.94)	0.009

Note: Values <0.05 are statistically significant.

Abbreviations: OR, odds ratio; CI, confidence interval.

Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated Guidelines for Reporting Parallel Group Randomised Trials. PLoS Med. 2010;7(3):e1000251. doi:10.1371/journal.pmed.1000251

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