Acetate Ringer's Solution Versus Normal Saline Solution in Sepsis: A Randomized, Controlled Trial

Abstract

Background Slaine solution (NSS) and Ringer’s acetate solution (RAS) are commonly given to critical ill patients as a fundamental fluid therapy. However, the effect of RAS and NSS on sepsis patient outcomes remains unknown. Methods We conducted a single-center prospective open-label parallel controlled trial to enroll adult patients (>18 years old) diagnosed with sepsis. Participants received either RAS or NSS for intravenous infusion for 5 days. The primary outcome was the incidence of Major adverse kidney events within 28 days (MAKE28). Secondary outcomes included 30-/90-day mortality, acute kidney injury (AKI), and hyperchloremia. The patients were then reclassified as NSS-only, RAS-only, and RAS+NSS groups according to the type of fluid they had received before enrollment. Thereafter, a secondary post hoc analysis was performed. Results 255 septic patients were screened and 143 patients (51.0% in RAS group and 49.0% in NSS group) were enrolled in the study. Each group received a median 2 L of fluid administration during 5 interventional days. 39.3% of patients had received 500 (500–1000) mL of balanced salt solutions (BSSs) prior to ICU admission. There was no statistical difference among the RAS and NSS group on the primary outcome MAKE28 in the initial analysis (23.3% vs. 20.0%, OR1.2 [0.6 to 2.2], p = 0.69). MAKE28 was observed in 23.3% of RAS-only versus 27.3% of NSS-only group patients (0.82 [0.35–1.94], P = 0.65) in the secondary post hoc analysis. The patients in NSS-only group had a longer Invasive Mechanical Ventilation days and a trend toward the accumulation of serum chloride. Conclusion This study observed no statistically significant difference on MAKE28 and secondary outcomes among sepsis patients receiving RAS and NSS. However, it is unclear whether the large amount of fluid resuscitation prior to ICU admission and carrier NSS narrowed the difference between BSSs and NSSs.