European journal of pharmacology · 2025
Early administration of lactated Ringer's solution and mortality in critically ill patients with heart failure: A retrospective cohort study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wang Peng-Fei, Guan Cheng-Jian, Chen Qian, Ma Huan, Su Su-Wen, Xiao Bing, Chen Ya-Li
Аннотация
BACKGROUND: Effective fluid management in critically ill patients with heart failure (HF) remains challenging. Lactate, beyond its traditional perception as a metabolic waste product, has emerged as an important myocardial energy substrate and modulator of cardiac function. This study evaluated whether early lactated Ringer's solution (LR) administration is associated with short-term and long-term outcomes in critically ill patients with HF.
METHODS: This retrospective cohort study included 12,354 HF patients admitted to intensive care units, derived from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were categorized based on early (≤24h) LR administration. Propensity Score Matching (PSM) and Inverse Probability of Treatment Weighting (IPTW) analyses were employed to balance baseline covariates between groups. Primary outcomes were in-hospital, 28-day, and 1-year mortality, evaluated using logistic regression and Cox proportional hazards models.
RESULTS: A total of 4138 patients received early LR infusion, and 8216 did not. After PSM, LR infusion was associated with lower in-hospital mortality (OR, 0.66 [95 %CI, 0.56-0.78]; P < 0.001), as well as lower 28-day (HR, 0.74 [95 %CI, 0.65-0.83]; P < 0.001) and 1-year mortality (HR, 0.77 [95 %CI, 0.70-0.84]; P < 0.001). IPTW analyses produced concordant estimates. Subgroup analyses showed broadly consistent associations across prespecified strata.
CONCLUSION: Early administration of LR was associated with lower short-term and long-term mortality among fluid-eligible ICU patients with HF in a mixed-fluid setting. These observational findings suggest further evaluation of fluid composition in this population. Randomized trials are warranted to confirm these associations and guide practice.
METHODS: This retrospective cohort study included 12,354 HF patients admitted to intensive care units, derived from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were categorized based on early (≤24h) LR administration. Propensity Score Matching (PSM) and Inverse Probability of Treatment Weighting (IPTW) analyses were employed to balance baseline covariates between groups. Primary outcomes were in-hospital, 28-day, and 1-year mortality, evaluated using logistic regression and Cox proportional hazards models.
RESULTS: A total of 4138 patients received early LR infusion, and 8216 did not. After PSM, LR infusion was associated with lower in-hospital mortality (OR, 0.66 [95 %CI, 0.56-0.78]; P < 0.001), as well as lower 28-day (HR, 0.74 [95 %CI, 0.65-0.83]; P < 0.001) and 1-year mortality (HR, 0.77 [95 %CI, 0.70-0.84]; P < 0.001). IPTW analyses produced concordant estimates. Subgroup analyses showed broadly consistent associations across prespecified strata.
CONCLUSION: Early administration of LR was associated with lower short-term and long-term mortality among fluid-eligible ICU patients with HF in a mixed-fluid setting. These observational findings suggest further evaluation of fluid composition in this population. Randomized trials are warranted to confirm these associations and guide practice.