The Effect of Early Fluid Resuscitation on Mortality in Sepsis: A Systematic Review and Meta-Analysis
Pooled result · Mortality, liberal vs restrictive fluid (3 RCTs)Result — go to the resultRelative risk 1.00 CI 0.81–1.24Authors' conclusion
For fluid resuscitation within 8 hours of sepsis diagnosis: 1) randomized trials suggest no mortality difference between more restrictive and more liberal fluid resuscitative strategies (certainty of evidence: low); 2) dosing less than 20 mL/kg has an effect on increased mortality (low certainty); 3) observational studies trend toward increased mortality with higher volume resuscitation (> 45 mL/kg) but are not supported by randomized trials (very low certainty); and 4) survival benefit is observed when 30 mL/kg is completed within 3 hours (low certainty).
Study context
- Population
- Adults (≥ 18 yr) with sepsis
- Participants
- 119,583 adults · 30 studies
- Comparison
- Early fluid dosing, timing and guideline-based resuscitation
- Outcome
- Mortality
Methodological detailsobservational data adjusted for confounding, PubMed, Scopus, Cochrane, and Google Scholar from January 1, 2000, to November 8, 2024
- Observational data adjusted for confounding
- PubMed, Scopus, Cochrane, and Google Scholar from January 1, 2000, to November 8, 2024
Pooled result
Mortality, liberal vs restrictive fluid (3 RCTs)
Relative risk
1.00
CI 0.81–1.24
As reported in the abstract
Further pooled results
Mortality risk with low fluid volumes (< 20 mL/kg)
- Eleven of 13 studies observed mortality risk (effect direction/sign test)
- P < 0.001
- Low certainty
Mortality risk with fluid volume > 45 mL/kg
- Six of 11 studies observed mortality risk
- P = 0.55
- Very low certainty
Survival with earlier completion of 30 mL/kg (within 3 hr)
- Four of four studies observed a survival benefit
- P = 0.12
- Low certainty
30 mL/kg by discrete time
- ≤ 1 and ≤ 2 hours: two studies observed survival benefit
- ≤ 3 hours: one study survival benefit, three no mortality impact
- ≤ 6 hours: two studies survival benefit, four no impact, two increased mortality risk (> 30 groups received > 50 and > 70 mL/kg)
Original publication
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