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Annals of Intensive Care

Table 2 Effects of balanced crystalloids versus 0.9% saline fluid on mortality and renal outcomes

From: Effects of chloride content of intravenous crystalloid solutions in critically ill adult patients: a meta-analysis with trial sequential analysis of randomized trials

Outcomes Balanced crystalloids 0.9% Saline Risk ratio/standard mean difference (95% CI)
In-hospital mortality Events/total Events/total Fixed models Random models
Waters et al. [20] 1/33 1/33 1.00 [0.07, 15.33] 1.00 [0.07, 15.33]
Takil et al. [21] 0/15 0/15 Not estimable Not estimable
Van Zyl et al. [22] 0/27 0/27 Not estimable Not estimable
Young et al. [23] 3/22 4/24 0.82 [0.21, 3.25] 0.82 [0.21, 3.25]
Young et al. [9] 87/1152 95/1110 0.88 [0.67, 1.17] 0.88 [0.67, 1.17]
Verma et al. [24] 5/33 2/34 2.58 [0.54, 12.36] 2.58 [0.54, 12.36]
Semler et al. [25] 72/520 68/454 0.92 [0.68, 1.26] 0.92 [0.68, 1.26]
Semler et al. [10] 818/7942 875/7860 0.93 [0.85, 1.01] 0.93 [0.85, 1.01]
Summary 986/9744 1045/9557 0.92 [0.85, 1.00] 0.92 [0.85, 1.00]
Fixed model heterogeneity: χ2 = 1.78, df = 5 (p = 0.88); I2 = 0%; test for overall effect: Z = 1.88 (p = 0.06)
Random model heterogeneity: τ2 = 0.00; χ2 = 1.78, df = 5 (p = 0.88); I2 = 0%; test for overall effect: Z = 1.89 (p = 0.06)
Outcomes Balanced crystalloids 0.9% Saline Risk ratio/standard mean difference (95% CI)
30-day mortality Events/total Events/total Fixed models Random models
Young et al. [23] 3/22 4/24 0.82 [0.21, 3.25] 0.82 [0.21, 3.25]
Semler et al. [25] 72/520 68/454 0.92 [0.68, 1.26] 0.92 [0.68, 1.26]
Semler et al. [10] 818/7942 875/7860 0.93 [0.85, 1.01] 0.93 [0.85, 1.01]
Summary 893/8484 947/8338 0.92 [0.85, 1.01] 0.92 [0.85, 1.01]
Fixed model heterogeneity: χ2 = 0.03, df = 2 (p = 0.98); I2 = 0%; test for overall effect: Z = 1.78 (p = 0.08)
Random model heterogeneity: τ2 = 0.00; χ2 = 0.03, df = 2 (p = 0.98); I2 = 0%; test for overall effect: Z = 1.78 (p = 0.08)
Outcomes Balanced crystalloids 0.9% Saline Risk ratio/standard mean difference (95% CI)
60-day mortality Events/total Events/total Fixed models Random models
Semler et al. [25] 87/520 83/454 0.92 [0.70, 1.20] 0.92 [0.70, 1.20]
Semler et al. [10] 928/7942 975/7860 0.94 [0.87, 1.02] 0.94 [0.87, 1.02]
Summary 1015/8462 1058/8314 0.94 [0.87, 1.02] 0.94 [0.87, 1.02]
Fixed model heterogeneity: heterogeneity: χ2 = 0.04, df = 1 (p = 0.84); I2 = 0%; test for overall effect: Z = 1.51 (p = 0.13)
Random model heterogeneity: τ2 = 0.00; χ2 = 0.04, df = 1 (p = 0.84); I2 = 0%; test for overall effect: Z = 1.52 (p = 0.13)
Outcomes Balanced crystalloids 0.9% Saline Risk ratio/standard mean difference (95% CI)
Development of stage 2 or higher AKI Events/total Events/total Fixed models Random models
Waters et al. [20] 4/33 5/33 0.80 [0.24, 2.72] 0.80 [0.24, 2.72]
Young et al. [23] 3/22 6/24 0.55 [0.15, 1.92] 0.55 [0.15, 1.92]
Young et al. [9] 105/1067 104/1025 0.97 [0.75, 1.25] 0.97 [0.75, 1.25]
Verma et al. [24] 1/33 3/34 0.34 [0.04, 3.14] 0.34 [0.04, 3.14]
Semler et al. [25] 97/520 87/454 0.97 [0.75, 1.26] 0.97 [0.75, 1.26]
Semler et al. [10] 807/7558 858/7458 0.93 [0.85, 1.02] 0.93 [0.85, 1.02]
Summary 1017/9233 1063/9028 0.93 [0.86, 1.01] 0.93 [0.86, 1.01]
Fixed model heterogeneity: χ2 = 1.74, df = 5 (p = 0.88); I2 = 0%; test for overall effect: Z = 1.71 (p = 0.09)
Random model heterogeneity: τ2 = 0.00; χ2 = 1.74, df = 5 (p = 0.88); I2 = 0%; test for overall effect: Z = 1.69 (p = 0.09)
Outcomes Balanced crystalloids 0.9% Saline Risk ratio/standard mean difference (95% CI)
New RRT use Events/total Events/total Fixed models Random models
Takil et al. [21] 0/15 0/15 Not estimable Not estimable
Young et al. [9] 38/1152 38/1110 0.96 [0.62, 1.50] 0.96 [0.62, 1.50]
Verma et al. [24] 5/33 3/34 1.72 [0.45, 6.62] 1.72 [0.45, 6.62]
Semler et al. [25] 24/520 14/454 1.50 [0.78, 2.86] 1.50 [0.78, 2.86]
Semler et al. [10] 189/7588 220/7458 0.84 [0.70, 1.02] 0.84 [0.70, 1.02]
Summary 256/9308 275/9071 0.91 [0.77, 1.07] 0.95 [0.75, 1.21]
Fixed model heterogeneity: χ2 = 3.77, df = 3 (p = 0.29); I2 = 20%; test for overall effect: Z = 1.16 (= 0.24)
Random model heterogeneity: τ2 = 0.01; χ2 = 3.77, df = 3 (p = 0.29); I2 = 20%; test for overall effect: Z = 0.38 (p = 0.70)
Outcomes Balanced crystalloids 0.9% Saline Risk ratio/standard mean difference (95% CI)
RRT-free days Mean ± SD, No. Mean ± SD, No. Fixed models Random models
Semler et al. [25] 24.9 ± 9.7, 520 23.7 ± 10, 520 0.12 [− 0.00, 0.25] 0.12 [− 0.00, 0.25]
Semler et al. [10] 25.6 ± 8.6, 7942 24.8 ± 8.9, 7860 0.09 [0.06, 0.12] 0.09 [0.06, 0.12]
Summary 0.09 [0.06, 0.12] 0.09 [0.06, 0.12]
Fixed model heterogeneity: χ2 = 0.38, df = 1 (p = 0.54); I2 = 0%, test for overall effect: Z = 6.02 (p < 0.00001)
Random model heterogeneity: τ2 = 0.00; χ2 = 0.21, df = 1 (p = 0.65); I2 = 0%; test for overall effect: Z = 6.03 (p < 0.00001)
  1. CI confident interval, AKI acute kidney injury, RRT renal replacement therapy, SD standard difference, SMD standard mean difference
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