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Lactated Ringer vs Normal Saline Solution During Sickle Cell Vaso-Occlusive Episodes.

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Lactated Ringer (LR) fluid resuscitation offers a slight but significant improvement in hospital-free days for sickle cell disease (SCD) patients experiencing vaso-occlusive episodes (VOEs) compared to normal saline (NS). LR is recommended over NS for fluid resuscitation in these patients.

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Area of Science:

  • Hematology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Sickle cell disease (SCD) is a genetic disorder causing painful vaso-occlusive episodes (VOEs).
  • Normal saline (NS) is commonly used for fluid resuscitation during VOEs, despite evidence suggesting it may worsen sickling.
  • The comparative effectiveness of alternative fluids like lactated Ringer (LR) is not well-established.

Purpose of the Study:

  • To compare the effectiveness of LR versus NS for fluid resuscitation in adult patients with SCD and VOEs.
  • To evaluate the impact of fluid resuscitation choice on hospital-free days (HFDs) and other clinical outcomes.

Main Methods:

  • A multicenter cohort study and target trial emulation using the Premier PINC AI database (2016-2022).
  • Included inpatient adults with SCD VOEs receiving either LR or NS on hospital day 1.
  • Primary outcome was HFDs by day 30, analyzed using targeted maximum likelihood estimation.

Main Results:

  • Patients receiving LR had more HFDs (0.4 days) compared to NS.
  • LR was associated with shorter hospital stays (-0.4 days) and lower 30-day readmission rates (-5.8%).
  • LR demonstrated superiority over NS for patients receiving 2 or more liters of fluid.

Conclusions:

  • LR fluid resuscitation offers a small but significant benefit over NS for SCD patients with VOEs.
  • LR should be preferred over NS for volume resuscitation in hospitalized SCD patients experiencing VOEs.
  • These findings have implications for fluid management strategies in SCD care.