Impact of Comorbidities on Beneficial Effect of Lactated Ringers vs. Saline in Sepsis Patients

Background: Lactated Ringers reduced mortality more than saline in sepsis patients but increased mortality more than saline in traumatic brain injury patients.Method: This prospective cohort study was conducted in a medical intensive care unit (ICU) in central Taiwan. We applied standard sepsis evaluation protocol and identified heart, lung, liver, kidney, and endocrine comorbidities. We also evaluated resuscitation response with central venous pressure, central venous oxygen saturation, and serum lactate level simultaneously. Propensity-score matching and Cox regression were used to estimate mortality. The competing risk model compared the lengths of hospital stays with the subdistribution hazard ratio (SHR).Results: Overall, 938 patients were included in the analysis. The lactated Ringers group had a lower mortality rate (adjusted hazard ratio, 0.59; 95% CI 0.43-0.81) and shorter lengths of hospital stay (SHR, 1.39; 95% C.I. 1.15-1.67) than the saline group; the differences were greater in patients with chronic pulmonary disease and small and non-significant in those with chronic kidney disease, moderate to severe liver disease and cerebral vascular disease. The resuscitation efficacy was the same between fluid types, but serum lactate levels were significantly higher in the lactated Ringers group than in the saline group (0.12 mg/dl/h; 95% C.I.: 0.03, 0.21), especially in chronic liver disease patients. Compared to the saline group, the lactated Ringers group achieved target glucose level earlier in both diabetes and non-diabetes patients.Conclusion: Lactate Ringer's solution provides greater benefits to patients with chronic pulmonary disease than to those with chronic kidney disease, or with moderate to severe liver disease. Comorbidities are important in choosing resuscitation fluid types.

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Impact of Comorbidities on Beneficial Effect of Lactated Ringers Versus Saline in Sepsis Patients

10.21203/rs.3.rs-689706/v1 ◽

2021 ◽

Author(s):

Chien Hua Tseng ◽

Tzu-Tao Chen ◽

Ming-Cheng Chan ◽

Kuan Yuan Chen ◽

Sheng Ming Wu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Liver Disease ◽

Kidney Disease ◽

Chronic Liver Disease ◽

Saline Group ◽

Serum Lactate ◽

Chronic Pulmonary Disease ◽

Fluid Type ◽

Central Venous ◽

Cerebral Vascular Disease

Abstract Background: Lactated Ringers reduced mortality more than saline in sepsis patients but increased mortality more than saline in traumatic brain injury patients. Method: This prospective cohort study included sepsis patients and identified heart, lung, liver, kidney, and endocrine comorbidities by detailed history taking and routine admission survey such as HbA1C, and liver functions. We evaluate resuscitation response with central venous pressure, central venous oxygen saturation, and serum lactate level simultaneously. Propensity-score matching and Cox regression were used to estimate 60-day mortality. The competing risk model compared the lengths of hospital and ICU stays with the subdistribution hazard ratio (SHR). Mixed-effect linear models were used to fit clinical variables and electrolyte trends.Results: Overall, 874 patients were included in the analysis; 636 patients were in the saline group, and 302 patients were in the lactated Ringers group. The lactated Ringers group had a lower mortality rate (adjusted hazard ratio, 0.59; 95% CI 0.43-0.81) and shorter lengths of hospital (SHR, 1.39; 95% C.I. 1.15-1.67) and ICU stays (SHR, 1.41; 95% CI 1.17, 1.71) than the saline group; the differences were greater in patients with chronic pulmonary disease and small and nonsignificant in those with chronic kidney disease, moderate to severe liver disease and cerebral vascular disease. The resuscitation efficacy was the same between fluid types, but serum lactate levels were significantly higher in the lactated Ringers group than in the saline group (0.12 mg/dL/hour; 95% C.I.: 0.03, 0.21), especially in chronic liver disease patients receiving lactated Ringers. The serum potassium level increased within the first few hours and recovered more slowly in patients with chronic kidney disease regardless of fluid type. Compared to the saline group, the lactated Ringers group achieved target glucose level earlier in both diabetes and non-diabetes patients.Conclusion: Patients receiving lactated Ringers had lower mortality and shorter lengths of hospital and ICU stays than those receiving saline, especially patients with chronic pulmonary disease, but there were no differences in those with chronic kidney disease, chronic liver disease and cerebral vascular disease. Comorbidities are important for clinicians to consider before choosing a fluid type.

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IMMUNE STATUS OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE, ACCOMPANIED WITH CHRONIC KIDNEY DISEASE AND METABOLIC DISTURBANCES

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.1(45).2015.02 ◽

2014 ◽

pp. 8-13

Author(s):

N.G. Bychkova ◽

S.A. Bychkova

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Pulmonary Disease ◽

Immune Status ◽

Cytokine Level ◽

Chronic Obstructive ◽

Chronic Pulmonary Disease ◽

Metabolic Disturbances ◽

Obstructive Pulmonary Disease ◽

Inflammatory Changes

The chronic kidney disease (CKD) is often accompanied to the chronic pulmonary disease (COPD) III stage and metabolic syndrome, (MS) which is because to the persistence of arterial hypertension and disturbances in hydrocarbon metabolism. Materials and methods. There were examined the 52 patients with III stage COPD, combined with MS, aged 51,3±4,2 years old, among them 23 with COPD, combined with MS and CKD I-IIstage (the main group). The compared group was included the 29 patients with COPD, combined with MS, without signs CKD. The all persons were examined by immunology investigation with the detection of cell and humoral immunity indexes and cytokine level. Results and discussion. The breath function data’s, the arterial hypertention stage and level did not have the significant differences. All the patients had the creatinine clearance not less than 60 ml/min/1,73m2. The detection of immune status shows the decrease of T-cell amount, especially the T-cytotoxical lymphocytes/ supressors, the significantly increase level ofactivated Tcells with early activated markers, those, which expressed adhesion molecule ICAM-1 and FAS- receptor, autoimmune and inflammatory changes in blood serum. Conclusions. The available ofСKD in patients COPD, combined with MS, initiated the more high activity of system immune inflammation in atherosclerosis manifestation as the morphological substrate of MS.

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1858-P: Bidirectional Relationship between Chronic Kidney Disease and Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus

Diabetes ◽

10.2337/db19-1858-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1858-P

Author(s):

HUI-CHUN HSU ◽

YU HUNG CHANG ◽

LINGWANG AN ◽

TAO-CHUN LEE

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Type 2 Diabetes Mellitus ◽

Liver Disease ◽

Kidney Disease ◽

Fatty Liver Disease ◽

Nonalcoholic Fatty Liver ◽

Bidirectional Relationship

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Severe liver disease is caused by HBV rather than HCV in children with hematological malignancies

The Hematology Journal ◽

10.1038/sj.thj.6200300 ◽

2003 ◽

Vol 4 (5) ◽

pp. 321-327 ◽

Cited By ~ 16

Author(s):

Manal H El-Sayed ◽

Magdy M Mohamed ◽

Amr Karim ◽

Anna-Maria Maina ◽

Filippo Oliveri ◽

...

Keyword(s):

Liver Disease ◽

Hematological Malignancies ◽

Severe Liver ◽

Severe Liver Disease

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HÆMORRHAGE IN SEVERE LIVER DISEASE

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1944.tb31157.x ◽

1944 ◽

Vol 2 (4) ◽

pp. 93-93

Keyword(s):

Liver Disease ◽

Severe Liver ◽

Severe Liver Disease

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Extra Lactate Dehydrogenase Isoenzyme Band in Serum of Patients with Severe Liver Disease

Clinical Chemistry ◽

10.1093/clinchem/17.9.882 ◽

1971 ◽

Vol 17 (9) ◽

pp. 882-885 ◽

Cited By ~ 6

Author(s):

T Lubrano ◽

A A Dietz ◽

H M Rubinstein

Keyword(s):

Liver Disease ◽

Lactate Dehydrogenase ◽

Serum Bilirubin ◽

High Serum ◽

Severe Liver ◽

Additional Band ◽

Dehydrogenase Isoenzyme ◽

Severe Liver Disease ◽

Isoenzyme Patterns ◽

High Serum Bilirubin

Abstract In a study of lactate dehydrogenase isoenzyme patterns in the sera of patients with severe liver disease, who were primarily selected because of an abnormally high serum bilirubin, 42 of 76 patients had an additional band (LDH-T) between isoenzymes 4 and 5 on acrylamide gel. Thirty of the 42 patients died during followup, 24 within a month of recognition of the extra band.

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